=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376747469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYNTHIA N. ELDERKIN, D.D.S., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2007
-----------------------------------------------------
Last Update Date | 01/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8015 CREEDMOOR RD SUITE 202
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27613-4397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-847-8747
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8015 CREEDMOOR RD SUITE 202
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27613-4397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-847-8747
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PRESIDENT
-----------------------------------------------------
Name | DR. CYNTHIA NICHOLS ELDERKIN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 919-847-8747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5662
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------