Organization
MEADOWS LUTCAVAGE SMITH VINTON FIDLER & LONG DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY J LUTCAVAGE D.D.S. (PARTNER)
(919) 736-2082
Entity
Organization
Contact information
Practice address
2400 WAYNE MEMORIAL DR, SUITE K, GOLDSBORO, NC 27534-1789
(919) 736-2082
(919) 734-0893
Mailing address
2400 WAYNE MEMORIAL DR, SUITE K, GOLDSBORO, NC 27534-1789
(919) 736-2082
(919) 734-0893
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016C1
BLUE CROSS BLUE SHIELD
NC
05
—
89016C1
—
NC
Enumeration date
05/10/2006
Last updated
09/18/2009
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