MEDICARE: DR PLUMMER ALSTON DANIEL JR DDS

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	5549	NC

General Provider Information

NPI Number	:	1497924724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR PLUMMER ALSTON DANIEL JR DDS

Provider Business Mailing Address
First Line	:	2300 WAYNE MEMORIAL DRIVE
Second Line	:	SUITE D
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1747
Country	:	US
Telephone Number	:	919-734-4716
Fax Number	:	919-734-7907

Provider Business Practice Location Address
First Line	:	2300 WAYNE MEMORIAL DRIVE
Second Line	:	SUITE D
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1747
Country	:	US
Telephone Number	:	919-734-4716
Fax Number	:	919-734-7907

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	MR. PLUMMER ALSTON DANIEL JR.
Credential	:	DDS
Telephone Number	:	919-734-4716

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	06/18/2008

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