Provider Demographics
NPI:1174679633
Name:GINA R. DAVIS DDS PA
Entity Type:Organization
Organization Name:GINA R. DAVIS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-547-8734
Mailing Address - Street 1:10320 MALLARD CREEK RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-9756
Mailing Address - Country:US
Mailing Address - Phone:704-547-8734
Mailing Address - Fax:704-547-9605
Practice Address - Street 1:10320 MALLARD CREEK RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9756
Practice Address - Country:US
Practice Address - Phone:704-547-8734
Practice Address - Fax:704-547-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty