Provider Demographics
NPI:1083738025
Name:DAVIS, JOANNA L (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 PARK VALLEY DR
Mailing Address - Street 2:#160
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4008
Mailing Address - Country:US
Mailing Address - Phone:512-341-7373
Mailing Address - Fax:512-341-8907
Practice Address - Street 1:16000 PARK VALLEY DR
Practice Address - Street 2:#160
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4008
Practice Address - Country:US
Practice Address - Phone:512-341-7373
Practice Address - Fax:512-341-8907
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics