Healthcare Provider Details

I. General information

NPI: 1811174352
Provider Name (Legal Business Name): DOUGLAS F. DEGROOTE, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 SHIPYARD BLVD STE 15
WILMINGTON NC
28403-8070
US

IV. Provider business mailing address

2250 SHIPYARD BLVD STE 15
WILMINGTON NC
28403-8070
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-1700
  • Fax: 910-452-3671
Mailing address:
  • Phone: 910-452-1700
  • Fax: 910-452-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4050
License Number StateNC

VIII. Authorized Official

Name: DR. DOUGLAS FORREST DEGROOTE
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 910-452-1700