Provider Demographics
NPI:1407149271
Name:CHRISTI M. DAVIS, DDS, PA, II
Entity Type:Organization
Organization Name:CHRISTI M. DAVIS, DDS, PA, II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-587-3802
Mailing Address - Street 1:10411 MONCREIFFE RD
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7819
Mailing Address - Country:US
Mailing Address - Phone:919-806-0200
Mailing Address - Fax:919-806-0211
Practice Address - Street 1:10411 MONCREIFFE RD
Practice Address - Street 2:SUITE 105B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7819
Practice Address - Country:US
Practice Address - Phone:919-806-0200
Practice Address - Fax:919-806-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902RUMedicaid