Organization
JERRY S. ALVIS, D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY SHUMATE ALVIS D.D.S. (OWNER/DENTIST)
(919) 782-5752
Entity
Organization
Contact information
Practice address
5603 DURALEIGH RD, SUITE 131, RALEIGH, NC 27612-2688
(919) 782-5752
Mailing address
5603 DURALEIGH RD, SUITE 131, RALEIGH, NC 27612-2688
(919) 782-5752
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
6792
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1455728
UNITED CONCORDIA
—
01
—
90065
BCBS
NC
05
—
ZP0000025
—
NC
Enumeration date
11/07/2007
Last updated
11/07/2007
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