Provider Demographics
NPI:1386319473
Name:FRAZELLE LEE AND WINNEBERGER ASSOCIATES PLLC
Entity type:Organization
Organization Name:FRAZELLE LEE AND WINNEBERGER ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/GENERAL DENTISTRY/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:WINNEBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-616-5530
Mailing Address - Street 1:1301 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7352
Mailing Address - Country:US
Mailing Address - Phone:910-762-0958
Mailing Address - Fax:910-762-2771
Practice Address - Street 1:1301 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7352
Practice Address - Country:US
Practice Address - Phone:910-762-0958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992872Medicaid
NC8995199Medicaid