Provider Demographics
NPI:1558771600
Name:NELSON AND DAVIS, DDS, PLLC
Entity Type:Organization
Organization Name:NELSON AND DAVIS, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-587-3802
Mailing Address - Street 1:11180 E FINCH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NC
Mailing Address - Zip Code:27557-7440
Mailing Address - Country:US
Mailing Address - Phone:703-587-3802
Mailing Address - Fax:919-806-0211
Practice Address - Street 1:11180 E FINCH AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NC
Practice Address - Zip Code:27557-7440
Practice Address - Country:US
Practice Address - Phone:703-587-3802
Practice Address - Fax:919-806-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5991122300000X
NC75331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912059627Medicaid
NC1174575799Medicaid