Provider Demographics
NPI:1003155086
Name:DAVIS, NICHOLAS C (DDS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 EASTBLUFF DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3505
Mailing Address - Country:US
Mailing Address - Phone:949-644-9211
Mailing Address - Fax:
Practice Address - Street 1:2503 EASTBLUFF DR
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3505
Practice Address - Country:US
Practice Address - Phone:949-644-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist