# THE CENTER FOR FUNCTIONAL & AESTHETIC FACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jeffrey S. Jelic, DMD, MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881761583
- **Authorized official:** MRS. JENNIFER THOMAS PICKETT (PATIENT CARE COORDINATOR)
- **Authorized official phone:** (919) 419-9222

## Contact information

- **Practice address:** 5501 FORTUNES RIDGE DR, SUITE G, DURHAM, NC 27713-6102
- **Practice address phone:** (919) 419-9222
- **Practice address fax:** (919) 419-9255
- **Mailing address:** 5501 FORTUNES RIDGE DR, SUITE G, DURHAM, NC 27713-6102
- **Mailing address phone:** (919) 419-9222
- **Mailing address fax:** (919) 419-9255

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 9900887 | NC | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 08/22/2020