Provider Demographics
NPI:1205844156
Name:DAVIS, PETER THOMAS (DDS FAGD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:THOMAS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WEST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5517
Mailing Address - Country:US
Mailing Address - Phone:610-865-3333
Mailing Address - Fax:610-691-7822
Practice Address - Street 1:201 WEST BROAD STREET
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5517
Practice Address - Country:US
Practice Address - Phone:610-865-3333
Practice Address - Fax:610-691-7822
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017836L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA130256OtherBCID
PAAD5582778OtherBNDD