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General NPI Number Information
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NPI Number | 1821027749
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Entity Type | Individual
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Provider Name | MERON NEGASH ANDEMICHAEL DDS
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Gender | Male
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 80 AUTUMN FERN TRAIL EAST CAROLINA UNIVERSITY SCHOOL OF DENTISTRY
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City | LILLINGTON
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State | NC
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Zip | 27546
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Country | US
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Telephone | 252-737-7350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 453
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City | LILLINGTON
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State | NC
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Zip | 27546-0453
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Country | US
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Telephone | 910-984-1556
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Fax | 910-984-1557
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5699
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9628
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License Number State | NC
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