Provider Demographics
NPI:1114146875
Name:PLUMMER, DAVID R J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R J
Last Name:PLUMMER
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 1:3801 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-3408
Mailing Address - Country:US
Mailing Address - Phone:336-744-1300
Mailing Address - Fax:336-744-9000
Practice Address - Street 1:3801 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-3408
Practice Address - Country:US
Practice Address - Phone:336-744-1300
Practice Address - Fax:336-744-9000
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC4801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC96945OtherBLUE CROSS BLUE SHIELD
NC8996945Medicaid