1982632915 NPI number — UNC ORAL & MAXILLOFACIAL

Table of content: (NPI 1982632915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982632915 NPI number — UNC ORAL & MAXILLOFACIAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNC ORAL & MAXILLOFACIAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNC ORAL AND MAXILLOFACIAL PATHOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982632915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 DENTAL CIR
Provider Second Line Business Mailing Address:
5603 KOURY OHSB CB 7450
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27599-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-537-3153
Provider Business Mailing Address Fax Number:
919-843-6508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 DENTAL CIR
Provider Second Line Business Practice Location Address:
5603 KOURY OHSB CB 7450
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27599-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-537-3153
Provider Business Practice Location Address Fax Number:
919-843-6508
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAH
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
919-537-3152

Provider Taxonomy Codes

  • Taxonomy code: 1223P0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34D0710634 . This is a "CLIA-88" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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