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General NPI Number Information
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NPI Number | 1093886954
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Entity Type | Organization
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Legal Business Name | MAURICE DAVIS DDS PA
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 ELM ST
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City | WELDON
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State | NC
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Zip | 27890
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Country | US
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Telephone | 252-536-3105
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Fax | 252-536-4607
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Provider Business Mailing Address
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Address Line | PO BOX 805 100 ELM ST
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City | WELDON
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State | NC
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Zip | 27890
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Country | US
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Telephone | 252-536-3105
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Fax | 252-536-4607
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Authorized Official
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Title or Position | OWNER
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Name | ANZELL MAURICE DAVIS
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Credential | DDS
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Telephone | 252-536-3105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4627
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License Number State | NC
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