Provider Demographics
NPI:1326120239
Name:DAVIS, ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
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 1:2003 E NC HIGHWAY 54
Mailing Address - Street 2:SUITE A
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2239
Mailing Address - Country:US
Mailing Address - Phone:919-806-8060
Mailing Address - Fax:919-806-8449
Practice Address - Street 1:2003 E NC HIGHWAY 54
Practice Address - Street 2:SUITE A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2239
Practice Address - Country:US
Practice Address - Phone:919-806-8060
Practice Address - Fax:919-806-8449
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990193Medicaid
NC845927OtherAETNA DENTAL
NC1554610OtherUNITED CONCORDIA
NC90193OtherBCBS OF NC