Provider Demographics
NPI:1497790596
Name:ALVIS, JERRY SHUMATE (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:SHUMATE
Last Name:ALVIS
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 DURALEIGH RD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2688
Mailing Address - Country:US
Mailing Address - Phone:919-782-5752
Mailing Address - Fax:919-782-5797
Practice Address - Street 1:5603 DURALEIGH RD
Practice Address - Street 2:SUITE 131
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2688
Practice Address - Country:US
Practice Address - Phone:919-782-5752
Practice Address - Fax:919-782-5797
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90065OtherBCBS
NC1455728OtherUNITED CONCORDIA