Provider Demographics
NPI:1871773341
Name:RICHARD E. ANGLIN, JR. DDS, MS, PA
Entity type:Organization
Organization Name:RICHARD E. ANGLIN, JR. DDS, MS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MS, PA
Authorized Official - Phone:910-980-1915
Mailing Address - Street 1:516 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4518
Mailing Address - Country:US
Mailing Address - Phone:910-980-1915
Mailing Address - Fax:910-980-1944
Practice Address - Street 1:516 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4518
Practice Address - Country:US
Practice Address - Phone:910-980-1915
Practice Address - Fax:910-980-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
126468OtherUNITED CONCORDIA INS CO
90258OtherBCBS