Basic Information
| Provider Information | |||||||||
| NPI: | 1528038650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | APICELLA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6837 NORMANDY DRIVE | ||||||||
| Address2: | BLDG 6-USA DENTAC | ||||||||
| City: | FT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106432196 | ||||||||
| FaxNumber: | 9103967017 | ||||||||
| Practice Location | |||||||||
| Address1: | 3866 FLOATING BRIDGE TRL | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284122389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019154658 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | 18434 | TX | N | Dental Providers | Dentist | Endodontics | 1223E0200X | 08815 | MD | Y | Dental Providers | Dentist | Endodontics | 1223E0200X | 9828 | NC | N | Dental Providers | Dentist | Endodontics |
ID Information
| ID | Type | State | Issuer | Description | BA6932847 | 01 | FEDERAL DEA | OTHER |