Provider Demographics
NPI:1720212145
Name:HENRY W. DAVIS,JR. II, DDS, PLLC
Entity Type:Organization
Organization Name:HENRY W. DAVIS,JR. II, DDS, PLLC
Other - Org Name:DENTURE MAKERS II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-892-4535
Mailing Address - Street 1:596B E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-9629
Mailing Address - Country:US
Mailing Address - Phone:910-892-4535
Mailing Address - Fax:910-892-0255
Practice Address - Street 1:2401 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2236
Practice Address - Country:US
Practice Address - Phone:919-833-1920
Practice Address - Fax:919-833-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205862018OtherINDIVIDUAL NPI NUMBER