NPIMap

Organization Active NPI

Perry L. Jeffries DDS, PA

  • Pediatric Dentistry
  • Winston Salem, NC
National Provider Identifier
1205076668
Registry record updated Feb 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
6832 Issued in NC
Legal business name
PERRY L. JEFFRIES DDS, PA
Practice address
1500 Mount Zion PL Ste B
Winston Salem, NC 27101-3254
Phone
(336) 748-0033
Fax
(336) 748-0414
NPI assigned
Feb 25, 2009
Last updated
Feb 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amelia Burnette, BA DAII
Title
Human Relations/Fin Coordinator
Phone
(336) 451-1957

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 6832 NC Primary

Addresses

Primary practice location

1500 Mount Zion PL Ste B
Winston Salem, NC 27101-3254

Mailing address

1500 Mount Zion PL Ste B
Winston Salem, NC 27101-3254
Phone (336) 748-0033

Other identifiers 1

IdentifierTypeStateIssuer
5907343MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Perry L Jeffries DDS PA8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1500 Mount Zion Pl
Ste B
Winston Salem, NC 27101
Phone (336) 748-0033

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235520000000",
    "number": "1205076668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MOUNT ZION PL STE B",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271013254",
            "telephone_number": "336-748-0033",
            "fax_number": "336-748-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 MOUNT ZION PL STE B",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271013254",
            "telephone_number": "336-748-0033",
            "fax_number": "336-748-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY L. JEFFRIES DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-25",
        "last_updated": "2009-02-25",
        "status": "A",
        "authorized_official_last_name": "BURNETTE",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "HUMAN RELATIONS/FIN COORDINATOR",
        "authorized_official_telephone_number": "336-451-1957",
        "authorized_official_credential": "BA DAII"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "6832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5907343",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.