MEDICARE: MAURICE DAVIS DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4627	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093886954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAURICE DAVIS DDS PA

Provider Business Mailing Address
First Line	:	PO BOX 805
Second Line	:	100 ELM ST
City	:	WELDON
State	:	NC
Zip	:	27890
Country	:	US
Telephone Number	:	252-536-3105
Fax Number	:	252-536-4607

Provider Business Practice Location Address
First Line	:	100 ELM ST
Second Line	:
City	:	WELDON
State	:	NC
Zip	:	27890
Country	:	US
Telephone Number	:	252-536-3105
Fax Number	:	252-536-4607

Authorized Official
Title or Position	:	OWNER
Name	:	ANZELL MAURICE DAVIS
Credential	:	DDS
Telephone Number	:	252-536-3105

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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