Basic Information
| Provider Information | |||||||||
| NPI: | 1861415804 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY OF NORTH CAROLINA HOSPITALS AT CHAPEL HILL | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | UNC HOSPITALS ORAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5221 PARAMOUNT PKWY STE 440 | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275605491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849741186 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | UNC HOSPITALS DENTAL CLINIC | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849741186 | ||||||||
| FaxNumber: | 9849741311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HADAR | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | TERESA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, UNC HOSPITALS | ||||||||
| AuthorizedOfficialTelephone: | 9849742819 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | 251S00000X | N | Agencies | Community/Behavioral Health | 133VN1004X | Y | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric |
ID Information
| ID | Type | State | Issuer | Description | 2489126 | 01 | NC | UHC PEDS CONTINUITY | OTHER | B0088 | 01 | NC | MEDCOST | OTHER | 2120334 | 01 | NC | ALLIANCE/MAMSI UCC | OTHER | 2638607 | 01 | NC | UHC UCC | OTHER | 3106615 | 01 | NY | ALLIANCE/MAMSI PEDS CONT | OTHER | 016NX | 01 | NC | BCBS NC | OTHER | 127402 | 01 | NC | MEDCOST | OTHER | 2053HOS | 01 | NC | PARTNERS | OTHER | 89016NX | 05 | NC | MEDICAID | 89016K2 | 05 | NC | MEDICAID |