Provider Demographics
NPI:1093886954
Name:MAURICE DAVIS DDS PA
Entity Type:Organization
Organization Name:MAURICE DAVIS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANZELL
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-536-3105
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:100 ELM ST
Mailing Address - City:WELDON
Mailing Address - State:NC
Mailing Address - Zip Code:27890
Mailing Address - Country:US
Mailing Address - Phone:252-536-3105
Mailing Address - Fax:252-536-4607
Practice Address - Street 1:100 ELM ST
Practice Address - Street 2:
Practice Address - City:WELDON
Practice Address - State:NC
Practice Address - Zip Code:27890
Practice Address - Country:US
Practice Address - Phone:252-536-3105
Practice Address - Fax:252-536-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992022Medicaid
NC8992022Medicaid