Provider Demographics
NPI:1033989967
Name:DAVIS, CHAR (PHDH)
Entity Type:Individual
Prefix:
First Name:CHAR
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W NORTH 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-1630
Mailing Address - Country:US
Mailing Address - Phone:217-259-9971
Mailing Address - Fax:
Practice Address - Street 1:2424 N 8TH ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-1547
Practice Address - Country:US
Practice Address - Phone:309-382-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist