Healthcare Provider Details

I. General information

NPI: 1578743597
Provider Name (Legal Business Name): JERRY S. ALVIS, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 DURALEIGH RD SUITE 131
RALEIGH NC
27612-2688
US

IV. Provider business mailing address

5603 DURALEIGH RD SUITE 131
RALEIGH NC
27612-2688
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-5752
  • Fax:
Mailing address:
  • Phone: 919-782-5752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number6792
License Number StateNC

VIII. Authorized Official

Name: DR. JERRY SHUMATE ALVIS
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 919-782-5752