1346628187 NPI number — HENRY W. DAVIS JR., DDS III PLLC

Table of content: (NPI 1346628187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346628187 NPI number — HENRY W. DAVIS JR., DDS III PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY W. DAVIS JR., DDS III PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346628187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
218 KEITH HILLS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LILLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27546-9766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 KEITH HILLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LILLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27546-9766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-319-4060
Provider Business Practice Location Address Fax Number:
844-700-0088
Provider Enumeration Date:
05/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-319-4060

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  054140 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com