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General NPI Number Information
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NPI Number | 1811497761
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Entity Type | Organization
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Legal Business Name | JEREMIAH C DAVIS, DDS, MBA, PA
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 6402 YADKIN RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303
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Country | US
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Telephone | 910-864-4646
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Fax |
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Provider Business Mailing Address
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Address Line | 7151 OKELLY CHAPEL RD # 318
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City | CARY
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State | NC
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Zip | 27519-6849
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Country | US
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Telephone | 910-864-4646
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEREMIAH C DAVIS
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Credential | DDS
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Telephone | 910-864-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9774
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License Number State | NC
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