Immediata, Anthony Russell
Immediata, Anthony Russell is an sole proprietor health care provider with primary practice located at 7101 Creedmoor Rd Suite 109, Raleigh NC 27613-1682. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Immediata, Anthony Russell can be contacted via phone (919) 846-5500.Contact Information
Primary practice address
7101 Creedmoor Rd Suite 109
Raleigh NC 27613-1682
Phone: (919) 846-5500
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 5022 | North Carolina |
Profile Details
| NPI number | 1609809292 |
|---|---|
| LBN Legal business name | Immediata, Anthony Russell |
| Credentials | DMD, PA |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 8th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609809292 | NPPES |
| North Carolina | MEDICAID | 8994426 |
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