Provider Demographics
NPI:1194838565
Name:DAVIS, T. BOB (DMD)
Entity Type:Individual
Prefix:DR
First Name:T. BOB
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8499 GREENVILLE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2412
Mailing Address - Country:US
Mailing Address - Phone:214-553-8499
Mailing Address - Fax:214-553-0142
Practice Address - Street 1:8499 GREENVILLE AVE STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2412
Practice Address - Country:US
Practice Address - Phone:214-553-8499
Practice Address - Fax:214-553-0142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX475454OtherUNITED CONCORDIA
TXB08760-01OtherDELTA DENTAL (CHIPS)