Healthcare Provider Details

I. General information

NPI: 1558771600
Provider Name (Legal Business Name): NELSON AND DAVIS, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 E FINCH AVE
MIDDLESEX NC
27557-7440
US

IV. Provider business mailing address

11180 E FINCH AVE
MIDDLESEX NC
27557-7440
US

V. Phone/Fax

Practice location:
  • Phone: 703-587-3802
  • Fax: 919-806-0211
Mailing address:
  • Phone: 703-587-3802
  • Fax: 919-806-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5991
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7533
License Number StateNC

VIII. Authorized Official

Name: DR. CHRISTI DAVIS
Title or Position: MEMBER
Credential: DDS
Phone: 703-587-3802