Provider Demographics
NPI:1013001171
Name:DAVIS, MATTHEW S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
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 1:12297 PENNSYLVANIA ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3165
Mailing Address - Country:US
Mailing Address - Phone:303-920-4196
Mailing Address - Fax:303-920-4198
Practice Address - Street 1:12297 PENNSYLVANIA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3165
Practice Address - Country:US
Practice Address - Phone:303-920-4196
Practice Address - Fax:303-920-4198
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics