DR. ANTHONY RUSSELL IMMEDIATA DMD PA NPI 1609809292

NPI Information

NPI: 1609809292
Provider Name: DR. ANTHONY RUSSELL IMMEDIATA, DMD, PA
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

PECOS Registration: Yes

Address:
7101 CREEDMOOR RD
SUITE 109
RALEIGH, NC
ZIP 27613
Phone: (919) 846-5500
Get Directions

DR. Anthony Russell Immediata, DMD, PA is an oral and maxillofacial surgery dentist in Raleigh, NC. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Anthony Russell Immediata, DMD, PA NPI is 1609809292. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

7101 CREEDMOOR RD
SUITE 109
RALEIGH, NC
ZIP 27613-682
Phone: (919) 846-5500

The NPI 1609809292 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 7/8/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223S0112X	Dentist	Oral and Maxillofacial Surgery	5022	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	8994426	MEDICAID	NORTH CAROLINA
2	U08372	MEDICARE UPIN	NORTH CAROLINA
3	2340076	MEDICARE ID-TYPE UNSPECIFIED	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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