Provider Demographics
NPI:1205862018
Name:DAVIS, HENRY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:W
Last Name:DAVIS
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 1:596B E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-9629
Mailing Address - Country:US
Mailing Address - Phone:910-892-4535
Mailing Address - Fax:910-892-0255
Practice Address - Street 1:596B E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-9629
Practice Address - Country:US
Practice Address - Phone:910-892-4535
Practice Address - Fax:910-892-0255
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992091Medicaid
NC8992091Medicaid