Provider Demographics
NPI:1083609838
Name:DAVIS, RONALD V (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:V
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 1:40 FOUR MILE DR STE 6
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2631
Mailing Address - Country:US
Mailing Address - Phone:406-755-6116
Mailing Address - Fax:
Practice Address - Street 1:40 FOUR MILE DR STE 6
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2631
Practice Address - Country:US
Practice Address - Phone:406-755-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61331223G0001X
CO1057521223G0001X
MT22111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice