Individual
DR. JOHN DAVID CIVILS JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1114 MAGNOLIA ST, GREENSBORO, NC 27401
(336) 272-4177
(336) 272-6313
Mailing address
PO BOX 13646, GREENSBORO, NC 27415
(336) 272-4177
(336) 272-6313
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7218
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89902V5
—
NC
01
—
902V5
BCBS
NC
Enumeration date
04/20/2006
Last updated
07/08/2007
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