1952792228 NPI number — PERRY L JEFFRIES DDS PA

Table of content: RAISSA DANTAS ANSTETT MD (NPI 1487276655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952792228 NPI number — PERRY L JEFFRIES DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERRY L JEFFRIES DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952792228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 MEADOWLANDS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBOROUGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27278-2686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-883-1523
Provider Business Practice Location Address Fax Number:
866-407-3096
Provider Enumeration Date:
02/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
AMELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
336-230-0346

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  6832 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588833131 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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