Provider Demographics
NPI:1093792475
Name:DAVIS, JOHN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
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:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-1283
Mailing Address - Country:US
Mailing Address - Phone:828-426-8525
Mailing Address - Fax:
Practice Address - Street 1:1966-B MORGANTON BLVD SW
Practice Address - Street 2:CALDWELL COUNTY HEALTH DEPT
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-0001
Practice Address - Country:US
Practice Address - Phone:828-426-8400
Practice Address - Fax:828-426-8450
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010146091223G0001X
NC82881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BD9098167OtherFEDERAL DEA
NCFD0034087OtherFEDERAL/STATE DEA