Provider Demographics
NPI:1528260049
Name:U. PHILLIP IGBINADOLOR, DMD., P.A.
Entity type:Organization
Organization Name:U. PHILLIP IGBINADOLOR, DMD., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UYIEKPEN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:IGBINADOLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-494-8484
Mailing Address - Street 1:2416 W SUGAR CREEK RD
Mailing Address - Street 2:P. O. BOX 26805
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3168
Mailing Address - Country:US
Mailing Address - Phone:704-494-8484
Mailing Address - Fax:704-494-8483
Practice Address - Street 1:2416 W SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3168
Practice Address - Country:US
Practice Address - Phone:704-494-8484
Practice Address - Fax:704-494-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901140Medicaid