1912121393 NPI number — ADAM T. DORSETT, DDS, AND JASON T. MOORE, DDS, PA

Table of content: (NPI 1912121393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912121393 NPI number — ADAM T. DORSETT, DDS, AND JASON T. MOORE, DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAM T. DORSETT, DDS, AND JASON T. MOORE, DDS, PA
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:
HILLSDALE DENTAL
Provider Other Organization Name Type Code:
5
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:
1912121393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 ROYAL TROON LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADVANCE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27006-6651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-998-2427
Provider Business Mailing Address Fax Number:
336-998-1088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 ROYAL TROON LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADVANCE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27006-6651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-998-2427
Provider Business Practice Location Address Fax Number:
336-998-1088
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DORSETT
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-998-2427

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5901813 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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