Basic Information
| Provider Information | |||||||||
| NPI: | 1639318744 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNC ORAL & MAXILLOFACIAL RADIOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIV OF NORTH CAROLINA AT CHAPEL HL | ||||||||
| Address2: | 101 BRAUER HALL CB 7450 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199662746 | ||||||||
| FaxNumber: | 9199666019 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIV OF NORTH CAROLINA AT CHAPEL HL | ||||||||
| Address2: | 101 BRAUER HALL CB 7450 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199662746 | ||||||||
| FaxNumber: | 9199666019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2009 | ||||||||
| LastUpdateDate: | 02/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | TYNDALL | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIR OMFS RADIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 9199662746 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0008X | 4820 | NC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Oral and Maxillofacial Radiology |
No ID Information.