Provider Demographics
NPI:1952323255
Name:DAVIS, CLARA POWELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:POWELL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899016MMedicaid
NC9016MOtherNCBCBS NUMBER