Basic Information
| Provider Information | |||||||||
| NPI: | 1952792228 | ||||||||
| EntityType: | 2 | ||||||||
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| 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: | 407 MEADOWLANDS DRIVE | ||||||||
| Address2: | |||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272782686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198831523 | ||||||||
| FaxNumber: | 8664073096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2015 | ||||||||
| LastUpdateDate: | 02/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | AMELIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3362300346 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 6832 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Pediatric Dentistry |
ID Information
| ID | Type | State | Issuer | Description | 1588833131 | 05 | NC | MEDICAID |