Provider Demographics
NPI:1184775371
Name:DAVIS, CHERRYL ANNE SR (DDS)
Entity type:Individual
Prefix:
First Name:CHERRYL
Middle Name:ANNE
Last Name:DAVIS
Suffix:SR
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 1:316 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3283
Mailing Address - Country:US
Mailing Address - Phone:252-247-4900
Mailing Address - Fax:252-247-4935
Practice Address - Street 1:316 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3283
Practice Address - Country:US
Practice Address - Phone:252-247-4900
Practice Address - Fax:252-247-4935
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9000VOtherBCBS PROVIDER NUMBER
NC970837OtherUNITED CONCORDIA PROVIDER
NC70066AMedicare UPIN