LAKE JEANETTE ORTHODONTICS AND PEDIATRIC DENTISTRY (NPI# 1124235205) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124235205 |
| Entity Type | Organization |
| Organization Name | LAKE JEANETTE ORTHODONTICS AND PEDIATRIC DENTISTRY |
| Practice Address |
3901 N Elm St Greensboro NC 27455-2594 |
| Practice Telephone | 3362860200 |
| Practice Fax Number | 3362860198 |
| Mailing Telephone | 3362860200 |
| Mailing Fax Number | 3362860198 |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2012-07-31 |
| Authorized Official Name | DR. MICHAEL A. IGNELZI JR. (OWNER) |
| Authorized Official Telephone | 3362860200 |
| Authorized Official Credential | DDS, PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
5606 | NC | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5904622 | 05 |
| Street Address |
3901 N ELM ST |
| City | GREENSBORO |
| State | NC |
| Zip Code | 27455-2594 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538582036 | Rebecca Glover Andrews | Dentist | 3901 N Elm St, Greensboro, NC 27455-2594 | 2014-02-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144677220 | Melanie Mitchell | Nurse Practitioner | 3909 N. Elm St, Suite 102, Greensboro, NC 27455 | 2016-05-19 |
| 1871723486 | Life Changes Family Services | Community/Behavioral Health | West Friendly Ave, 5415 Suite A, Greensboro, NC 27455 | 2009-07-16 |
| 1497996805 | Mark Ellis Hepler | Physician Assistant | 3625 N Elm St Ste 110a, Greensboro, NC 27455 | 2009-03-13 |
| 1629217096 | Shemena Monique Wiggins | Physical Therapist | 3823 Lawndale Dr., Loyalton of Greensboro, Greensboro, NC 27455 | 2009-02-09 |
| 1154588036 | Coley Cosmetic & Hand Surgery Center, Pa | Clinic/Center | 3820 N Elm Street, Suite 104, Greensboro, NC 27455 | 2008-05-19 |
| 1447428693 | Regina G Kujawa | Social Worker | 1904 Kello Dr, Greensboro, NC 27455 | 2008-02-11 |
| 1942322805 | Benjamin Dale Weston | Dentist | 6161-a Lake Brandt Rd, Greensboro, NC 27455 | 2007-04-04 |
| 1992857007 | Five Star Quality Care - Obx Operator, LLC | Assisted Living Facility | 3896 North Elm Street, Greensboro, NC 27455 | 2007-01-17 |
| 1043312077 | Harris Teeter, LLC | Durable Medical Equipment & Medical Supplies | 401 Pisgah Church Rd., Greensboro, NC 27455 | 2006-09-01 |
| 1740296557 | Melanie Mcneely Boatwright | Nurse Practitioner | 3803 N. Elm St., Greensboro, NC 27455 | 2006-08-01 |
| Find all providers in zip 27455 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790283844 | Naomi Lane, D.d.s., P.a. | Dentist | 2600-a Oakcrest Ave, Greensboro, NC 27408 | 2018-01-24 |
| 1578071221 | Knowles, Smith and Associates, LLP | Dentist | 510 Hickory Ridge Dr Ste 101, Greensboro, NC 27409-9779 | 2018-01-16 |
| 1174064539 | Lakeside Pediatric Dentistry, LLC | Dentist | 1050 Parkside Cmns, Suite 103, Greensboro, GA 30642-4524 | 2017-03-17 |
| 1760636997 | Sona J Isharani | Dentist | 2707 Pinedale Rd Ste C, Greensboro, NC 27408-2020 | 2008-11-14 |
| 1609085950 | Lott Cuffie Southwest Properties | Dentist | 1050 Parkside Commons, Suite 103, Greensboro, GA 30642 | 2007-05-22 |
| 1427180801 | Thane C. Hisaw | Dentist | 504 E Cornwallis Dr, Ste. #j, Greensboro, NC 27405-5679 | 2007-03-12 |
| 1144310517 | Michael Anthony Ignelzi Jr. | Dentist | 3901 North Elm Street, Greensboro, NC 27455-2594 | 2006-10-13 |
| 1154438299 | Edward Mark Miller | Dentist | 504 East Cornwallis Dr J, Greensboro, NC 27405 | 2006-08-24 |
| 1124050877 | Marc E. Goldenberg | Dentist | 5408 W Friendly Ave, Greensboro, NC 27410-4367 | 2006-07-06 |
| 1083643290 | Goldenberg Pierce & Applebaum Dds Pllc | Dentist | 5408 W Friendly Avenue, Greensboro, NC 27410 | 2006-07-01 |
| Find all providers in GREENSBORO | ||||
| City | GREENSBORO |
| Zip Code | 27455 |
Please comment or provide details below to improve the information on LAKE JEANETTE ORTHODONTICS AND PEDIATRIC DENTISTRY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.