Provider Demographics
NPI:1205030939
Name:DAVIS, KEVIN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LONG PRAIRIE RD
Mailing Address - Street 2:STE 132
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4217
Mailing Address - Country:US
Mailing Address - Phone:972-874-7870
Mailing Address - Fax:972-874-7065
Practice Address - Street 1:1900 LONG PRAIRIE RD
Practice Address - Street 2:STE 132
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4217
Practice Address - Country:US
Practice Address - Phone:972-874-7870
Practice Address - Fax:972-874-7065
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice