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Provider Information for 1134184096



DR. JOHN DAVID CIVILS JR. DDS

Gender: MALE

Individual NPI: 1134184096

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1134184096
Enumeration Date 2006-04-20
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address PO BOX 13646
GREENSBORO, NC 27415
United States

Phone: 336-272-4177 | Fax: 336-272-6313
View Map External Link
Primary Practice Address 1114 MAGNOLIA ST
GREENSBORO, NC 27401
United States

Phone: 336-272-4177 | Fax: 336-272-6313
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID NC 89902V5
Other BCBS NC 902V5
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist NC 7218