Provider Demographics
NPI:1730169459
Name:POWERS, DAVID BRYAN (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRYAN
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:40 DUKE MEDICINE CIR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4000
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:919-620-4921
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6486122300000X
IN01056641A204E00000X
NC2005-01600204E00000X
MDD0066918204E00000X
FLME109928204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003988800Medicaid
MD413880500Medicaid
FL003988800Medicaid
FLS150Medicare PIN