Individual
DR. JERRY WAYNE CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6708 REGAL OAKS DRIVE, REGAL OAKS DENTAL OFFICE, CHARLOTTE, NC 28212
(704) 536-0269
(704) 536-7520
Mailing address
6708 REGAL OAKS DRIVE, REGAL OAKS DENTAL OFFICE, CHARLOTTE, NC 28212
(704) 536-0269
(704) 536-7520
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3658
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
91555
BCBS
—
Enumeration date
11/20/2006
Last updated
07/08/2007
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