Provider Demographics
NPI:1033770953
Name:DAVIS, CHAD JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JOSEPH
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 1:3811 CERRILLOS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4149
Mailing Address - Country:US
Mailing Address - Phone:505-933-6872
Mailing Address - Fax:903-677-2852
Practice Address - Street 1:3811 CERRILLOS RD STE 104
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4149
Practice Address - Country:US
Practice Address - Phone:505-933-6872
Practice Address - Fax:505-930-5682
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist