Healthcare Provider Details

I. General information

NPI: 1710900592
Provider Name (Legal Business Name): CHRISTOPHER LEE DAVIS D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 S CHURCH ST #603
BURLINGTON NC
27215-5390
US

IV. Provider business mailing address

2260 S CHURCH ST #603
BURLINGTON NC
27215-5390
US

V. Phone/Fax

Practice location:
  • Phone: 336-222-8792
  • Fax: 336-222-8795
Mailing address:
  • Phone: 336-222-8792
  • Fax: 336-222-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4186
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number26220
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: