MEDICARE: J DAVID CIVILS & JANNA C CIVILS 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	122300000X	Dentist	7418
2	122300000X	Dentist	7263

General Provider Information

NPI Number	:	1871558726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J DAVID CIVILS & JANNA C CIVILS DDS PA

Provider Business Mailing Address
First Line	:	PO BOX 13646
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27415
Country	:	US
Telephone Number	:	336-272-4177
Fax Number	:	336-272-6313

Provider Business Practice Location Address
First Line	:	1114 MAGNOLIA ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401
Country	:	US
Telephone Number	:	336-272-4177
Fax Number	:	336-272-6313

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JONN DAVID CIVILS JR.
Credential	:	DDS
Telephone Number	:	336-272-4177

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	09/11/2025

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