Healthcare Provider Details

I. General information

NPI: 1639318744
Provider Name (Legal Business Name): UNC ORAL & MAXILLOFACIAL RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIV OF NORTH CAROLINA AT CHAPEL HL 101 BRAUER HALL CB 7450
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

UNIV OF NORTH CAROLINA AT CHAPEL HL 101 BRAUER HALL CB 7450
CHAPEL HILL NC
27599-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-2746
  • Fax: 919-966-6019
Mailing address:
  • Phone: 919-966-2746
  • Fax: 919-966-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number4820
License Number StateNC

VIII. Authorized Official

Name: DR. DONALD A TYNDALL
Title or Position: CHAIR OMFS RADIOLOGIST
Credential: DDS
Phone: 919-966-2746