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General NPI Number Information
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NPI Number | 1861643678
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Entity Type | Organization
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Legal Business Name | ANTHONY R. IMMEDIATA, D.M.D, P.A.
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 7101 CREEDMOOR RD SUITE 109
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City | RALEIGH
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State | NC
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Zip | 27613-1682
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Country | US
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Telephone | 919-846-5500
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Fax | 919-846-7964
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Provider Business Mailing Address
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Address Line | 7101 CREEDMOOR RD SUITE 109
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City | RALEIGH
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State | NC
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Zip | 27613-1682
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Country | US
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Telephone | 919-846-5500
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Fax | 919-846-7964
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. BARBARA SED
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Credential |
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Telephone | 919-846-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5022
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License Number State | NC
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