Provider Demographics
NPI:1225041437
Name:DAVIDSON, DANIEL B (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:DAVIDSON
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 1:509 W HANLEY AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COEURDALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8994
Mailing Address - Country:US
Mailing Address - Phone:208-667-5447
Mailing Address - Fax:208-666-8918
Practice Address - Street 1:509 W HANLEY AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:COEURDALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8994
Practice Address - Country:US
Practice Address - Phone:208-667-5447
Practice Address - Fax:208-666-8918
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD18131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice