Healthcare Provider Details

I. General information

NPI: 1912977802
Provider Name (Legal Business Name): MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 PENNY LANE
MOREHEAD CITY NC
28557
US

IV. Provider business mailing address

501 PENNY LANE
MOREHEAD CITY NC
28557
US

V. Phone/Fax

Practice location:
  • Phone: 252-247-2258
  • Fax: 252-247-7783
Mailing address:
  • Phone: 252-247-2258
  • Fax: 252-247-7783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4872
License Number StateNC

VIII. Authorized Official

Name: JEFFREY RALPH VINTON
Title or Position: PARTNER
Credential: D.D.S.
Phone: 252-247-2258