MEDICARE: DR. EDSEL NEIL CLINE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8213	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9027C	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1578662284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDSEL NEIL CLINE D.M.D.

Provider Business Mailing Address
First Line	:	205B RESERVE GREEN DR
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-8947
Country	:	US
Telephone Number	:	252-726-9403
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 ATLANTIC BEACH CSWY
Second Line	:
City	:	ATLANTIC BEACH
State	:	NC
Zip	:	28512-7341
Country	:	US
Telephone Number	:	252-247-6704
Fax Number	:	252-247-3670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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