MEDICARE: E.SMOAK ACKERMAN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5469	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1316022700	OTHER	NC	INDIVIUAL NPI #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154503282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E.SMOAK ACKERMAN PLLC

Provider Business Mailing Address
First Line	:	66 WHEATON DR
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-8691
Country	:	US
Telephone Number	:	919-488-0233
Fax Number	:	919-488-0234

Provider Business Practice Location Address
First Line	:	66 WHEATON DR
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-8691
Country	:	US
Telephone Number	:	919-488-0233
Fax Number	:	919-488-0234

Authorized Official
Title or Position	:	PRESIDENT/DENTIST
Name	:	DR. EMMETT SMOAK ACKERMAN JR.
Credential	:	DDS
Telephone Number	:	919-488-0233

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	11/30/2007

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