Provider Demographics
NPI:1033893417
Name:DAVICO, MEKAYLA
Entity Type:Individual
Prefix:DR
First Name:MEKAYLA
Middle Name:
Last Name:DAVICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAPLEVILLE DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:ST. ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478
Mailing Address - Country:US
Mailing Address - Phone:802-524-4844
Mailing Address - Fax:
Practice Address - Street 1:34 MAPLEVILLE DEPOT RD
Practice Address - Street 2:
Practice Address - City:ST. ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478
Practice Address - Country:US
Practice Address - Phone:802-524-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0134188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist