Provider Demographics
NPI:1043940257
Name:DAVIS, ANNE (RDH, DT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RDH, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2402
Mailing Address - Country:US
Mailing Address - Phone:218-728-6445
Mailing Address - Fax:
Practice Address - Street 1:1225 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2402
Practice Address - Country:US
Practice Address - Phone:218-728-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH11028124Q00000X
MNDT138125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist