Provider Demographics
NPI:1114111747
Name:DAVIS DENTAL CENTERS, LLC
Entity Type:Organization
Organization Name:DAVIS DENTAL CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-908-0651
Mailing Address - Street 1:1810 BROADRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-9329
Mailing Address - Country:US
Mailing Address - Phone:540-908-0651
Mailing Address - Fax:
Practice Address - Street 1:116 W SPOTSWOOD AVE
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827-1119
Practice Address - Country:US
Practice Address - Phone:540-298-9419
Practice Address - Fax:540-298-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008683261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental