Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 8803 | NC |
N | 1223S0112X | Oral and Maxillofacial Surgeon | OS36302 | MS |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2009-01628 | NC |
NPI | 1528284916 |
---|---|
Provider Name | Dr. James Richard Hupp |
First Address | Greenville, NC 27834 |
Second Address | Greenville, NC 27834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 13/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0660447 | (05) | MS |