Provider Demographics
NPI:1942633482
Name:EAST CAROLINA UNIVERSITY
Entity type:Organization
Organization Name:EAST CAROLINA UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEAN, SCHOOL OF DENTAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:CHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:252-737-7000
Mailing Address - Street 1:80 AUTUMN FERN TRAIL
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546
Mailing Address - Country:US
Mailing Address - Phone:910-814-4191
Mailing Address - Fax:910-814-4198
Practice Address - Street 1:80 AUTUMN FERN TRAIL
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546
Practice Address - Country:US
Practice Address - Phone:910-814-4191
Practice Address - Fax:910-814-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty