| Organization Name: | EAST CAROLINA UNIVERSITY SCHOOL OF DENTAL MEDICINE |
| NPI Number: | 1275806762 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL L. SCHOLTZ (DIRECTOR, COMMUNITY DENTAL PRACTICE) |
| Mailing Address: | 100 Health Center Drive Ahoskie |
| State: | NC US |
| Postal Code: | 27910 |
| Phone Number: | 2527377000 |
| Fax Number: | 2527377049 |
| NPI Enumeration Date: | 02/15/2012 |
| NPI Last Update Date: | 02/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | NC9053 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |