MEDICARE: PERRY L. JEFFRIES DDS PA

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	1223P0221X	Pediatric Dentistry	6832	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255751319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY L. JEFFRIES DDS PA

Provider Business Mailing Address
First Line	:	871 HUFFMAN ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-7205
Country	:	US
Telephone Number	:	336-230-0346
Fax Number	:	336-230-0348

Provider Business Practice Location Address
First Line	:	311 N FIR AVE
Second Line	:
City	:	SILER CITY
State	:	NC
Zip	:	27344-3071
Country	:	US
Telephone Number	:	919-799-7400
Fax Number	:	919-799-7397

Authorized Official
Title or Position	:	DDS/OWNER
Name	:	PERRY L JEFFRIES
Credential	:	DDS
Telephone Number	:	336-230-0346

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	08/22/2014

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