Provider Demographics
NPI:1891893426
Name:CECIL, JEFFREY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:CECIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2153
Mailing Address - Country:US
Mailing Address - Phone:919-479-5028
Mailing Address - Fax:919-471-2610
Practice Address - Street 1:4115 CAPITOL ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2153
Practice Address - Country:US
Practice Address - Phone:919-479-5028
Practice Address - Fax:919-471-2610
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991479Medicaid
NC8991479Medicaid