Provider Demographics
NPI:1073916607
Name:DAVIES DENTAL PC
Entity Type:Organization
Organization Name:DAVIES DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-865-6265
Mailing Address - Street 1:101 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-2601
Mailing Address - Country:US
Mailing Address - Phone:508-865-6265
Mailing Address - Fax:508-865-3985
Practice Address - Street 1:101 ELM ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2601
Practice Address - Country:US
Practice Address - Phone:508-865-6265
Practice Address - Fax:508-865-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN193351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty