MEDICARE: DAVID J MAYBERRY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4792	NC

General Provider Information

NPI Number	:	1043213044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J MAYBERRY DDS

Provider Business Mailing Address
First Line	:	1539 E INNES ST
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28146-6018
Country	:	US
Telephone Number	:	704-637-1232
Fax Number	:	704-637-0446

Provider Business Practice Location Address
First Line	:	1539 E INNES ST
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28146-6018
Country	:	US
Telephone Number	:	704-637-1232
Fax Number	:	704-637-0446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/26/2008

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