Provider Demographics
NPI:1225894397
Name:DAVIS, TAWANNA SHERRELL (RDH)
Entity Type:Individual
Prefix:MS
First Name:TAWANNA
Middle Name:SHERRELL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 INGRAHAM ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3602
Mailing Address - Country:US
Mailing Address - Phone:202-210-2761
Mailing Address - Fax:
Practice Address - Street 1:1145 19TH ST NW STE 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3719
Practice Address - Country:US
Practice Address - Phone:202-293-9192
Practice Address - Fax:202-293-9195
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000359124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist