Provider Demographics
NPI:1114335635
Name:DR. MAGGIE N. DAVIS, D.M.D., LLC
Entity Type:Organization
Organization Name:DR. MAGGIE N. DAVIS, D.M.D., LLC
Other - Org Name:JOHNNY JOHNSON, DMD & MAGGIE DAVIS, DMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-951-2182
Mailing Address - Street 1:3840 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3600
Mailing Address - Country:US
Mailing Address - Phone:727-786-7551
Mailing Address - Fax:727-784-7644
Practice Address - Street 1:3840 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3600
Practice Address - Country:US
Practice Address - Phone:727-786-7551
Practice Address - Fax:727-784-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN179481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty