Provider Demographics
NPI:1063022135
Name:DAVIS, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DAVIS
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 1:545 MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04087-3001
Mailing Address - Country:US
Mailing Address - Phone:207-432-7571
Mailing Address - Fax:207-247-2221
Practice Address - Street 1:545 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04087-3001
Practice Address - Country:US
Practice Address - Phone:207-432-7571
Practice Address - Fax:207-247-2221
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant