MEDICARE: DR. DOUGLAS FORREST DEGROOTE DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	4050	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679573976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS FORREST DEGROOTE DDS

Provider Business Mailing Address
First Line	:	2250 SHIPYARD BLVD
Second Line	:	SUITE 15
City	:	WILMINGTON
State	:	NC
Zip	:	28403-8070
Country	:	US
Telephone Number	:	910-452-1700
Fax Number	:	910-452-3671

Provider Business Practice Location Address
First Line	:	2250 SHIPYARD BLVD
Second Line	:	SUITE 15
City	:	WILMINGTON
State	:	NC
Zip	:	28403-8070
Country	:	US
Telephone Number	:	910-452-1700
Fax Number	:	910-452-3671

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/17/2012

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