Provider Demographics
NPI:1043399868
Name:DAVIS, RICHARD JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
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:PO BOX U
Mailing Address - Street 2:
Mailing Address - City:HURLOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21643
Mailing Address - Country:US
Mailing Address - Phone:410-943-4848
Mailing Address - Fax:
Practice Address - Street 1:300 COLLINS AVE
Practice Address - Street 2:HURLOCK MEDICAL CENTER
Practice Address - City:HURLOCK
Practice Address - State:MD
Practice Address - Zip Code:21643
Practice Address - Country:US
Practice Address - Phone:410-943-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD074361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice