Healthcare Provider Details

I. General information

NPI: 1174575799
Provider Name (Legal Business Name): CHRISTI MICHELLE DAVIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10411 MONCREIFFE ROAD SUITE 105B
RALEIGH NC
27617-6452
US

IV. Provider business mailing address

11020 PRESIDIO DR
RALEIGH NC
27617-7772
US

V. Phone/Fax

Practice location:
  • Phone: 919-806-0200
  • Fax: 919-806-0211
Mailing address:
  • Phone: 919-293-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7533
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: