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NPI Code Detail

MEDICARE: THEODORE GABRIEL MUCHITENI D.M.D.

MEDICARE: THEODORE GABRIEL MUCHITENI D.M.D.
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
11223S0112XOral and Maxillofacial Surgery (Dentist)5566NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
169278OTHERNCBLUE CROSS BLUE SHIELD OF
2523612OTHERUNITED CONCORDIA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4208734OTHERTRIGON BCBS

General Provider Information

NPI Number : 1366444085
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE GABRIEL MUCHITENI D.M.D.
Provider Business Mailing Address
First Line : 2300 HEMBY LN
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-3775
Country : US
Telephone Number : 252-830-0201
Fax Number : 252-830-2052
Provider Business Practice Location Address
First Line : 2300 HEMBY LN
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-3775
Country : US
Telephone Number : 252-830-0201
Fax Number : 252-830-2052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 06/13/2008

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