Provider Demographics
NPI:1184837445
Name:DAVIS, JEFFREY PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
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 1:7601 LEWISVILLE RD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102
Mailing Address - Country:US
Mailing Address - Phone:703-798-2755
Mailing Address - Fax:
Practice Address - Street 1:7601 LEWINSVILLE RD
Practice Address - Street 2:SUITE #208
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2814
Practice Address - Country:US
Practice Address - Phone:703-848-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010089471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry