Provider Demographics
NPI:1073553038
Name:DAVIS, RICHARD C JR (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:DAVIS
Suffix:JR
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 1:1600 9TH ST
Mailing Address - Street 2:ROOM 205 MAILSTOP 2-3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-6414
Mailing Address - Country:US
Mailing Address - Phone:916-654-2431
Mailing Address - Fax:916-654-3186
Practice Address - Street 1:24511 WEST JAYNE AVE
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-5000
Practice Address - Country:US
Practice Address - Phone:559-935-4301
Practice Address - Fax:559-935-7118
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice