Provider Demographics
NPI:1174674485
Name:DAVIS, MEREDITH LEIGH (DMD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LEIGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-1531
Mailing Address - Country:US
Mailing Address - Phone:207-443-9721
Mailing Address - Fax:207-443-9722
Practice Address - Street 1:171 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1531
Practice Address - Country:US
Practice Address - Phone:207-443-9721
Practice Address - Fax:207-443-9722
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice