Provider Demographics
NPI:1043213044
Name:MAYBERRY, DAVID J (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MAYBERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 E INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-6018
Mailing Address - Country:US
Mailing Address - Phone:704-637-1232
Mailing Address - Fax:704-637-0446
Practice Address - Street 1:1539 E INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6018
Practice Address - Country:US
Practice Address - Phone:704-637-1232
Practice Address - Fax:704-637-0446
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice