Basic Information
| Provider Information | |||||||||
| NPI: | 1588833131 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PERRY L. JEFFRIES DDS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 871 HUFFMAN ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274057205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362300346 | ||||||||
| FaxNumber: | 3362300348 | ||||||||
| Practice Location | |||||||||
| Address1: | 871 HUFFMAN ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274057205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362300346 | ||||||||
| FaxNumber: | 3362300348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2008 | ||||||||
| LastUpdateDate: | 02/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | JEFFRIES | ||||||||
| AuthorizedOfficialFirstName: | PERRY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DDS | ||||||||
| AuthorizedOfficialTelephone: | 3362300346 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 6832 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 90132 | 01 | NC | BCBS | OTHER | 5907507 | 05 | NC | MEDICAID |