Healthcare Provider Details

I. General information

NPI: 1730299835
Provider Name (Legal Business Name): DRS PEARSON JEFFERSON AND CAMP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 BANDFORD WAY SUITE 121
RALEIGH NC
27615-2767
US

IV. Provider business mailing address

8301 BANDFORD WAY SUITE 121
RALEIGH NC
27615-2767
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-4746
  • Fax: 919-876-5071
Mailing address:
  • Phone: 919-876-4746
  • Fax: 919-876-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY A JEFFERSON
Title or Position: TREASURER
Credential: DDS
Phone: 919-876-4746