Provider Demographics
NPI:1497026058
Name:CHRISTI M. DAVIS, DDS, PA III
Entity Type:Organization
Organization Name:CHRISTI M. DAVIS, DDS, PA III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-782-9560
Mailing Address - Street 1:2406 BLUE RIDGE ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6452
Mailing Address - Country:US
Mailing Address - Phone:919-782-9560
Mailing Address - Fax:
Practice Address - Street 1:2406 BLUE RIDGE ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6452
Practice Address - Country:US
Practice Address - Phone:919-782-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-09-10
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