Provider Demographics
NPI:1952792228
Name:PERRY L JEFFRIES DDS PA
Entity type:Organization
Organization Name:PERRY L JEFFRIES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-230-0346
Mailing Address - Street 1:871 HUFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7205
Mailing Address - Country:US
Mailing Address - Phone:336-230-0346
Mailing Address - Fax:336-230-0348
Practice Address - Street 1:407 MEADOWLANDS DRIVE
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2686
Practice Address - Country:US
Practice Address - Phone:919-883-1523
Practice Address - Fax:866-407-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588833131Medicaid