Provider Demographics
NPI:1578735080
Name:CLARA P DAVIS, DDS, PLLC
Entity Type:Organization
Organization Name:CLARA P DAVIS, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:POWELL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-598-9001
Mailing Address - Street 1:121 SHERRON RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9515
Mailing Address - Country:US
Mailing Address - Phone:919-598-0780
Mailing Address - Fax:919-598-0781
Practice Address - Street 1:121 SHERRON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9515
Practice Address - Country:US
Practice Address - Phone:919-598-0780
Practice Address - Fax:919-598-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899016MMedicaid
NC9016MOtherBCBS