Provider Demographics
NPI:1033522198
Name:DAVIS, JEREMIAH C (DDS, MBA)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 O'KELLY ROAD (BOX 318)
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519
Mailing Address - Country:US
Mailing Address - Phone:910-864-4646
Mailing Address - Fax:910-864-6271
Practice Address - Street 1:6402 YADKIN ROAD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-864-4646
Practice Address - Fax:910-864-6271
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist