Provider Demographics
NPI:1275625196
Name:DAVIS, MARK EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:3535 VICTORY GROUP WAY STE 605
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6742
Mailing Address - Country:US
Mailing Address - Phone:972-335-8717
Mailing Address - Fax:972-731-0264
Practice Address - Street 1:3535 VICTORY GROUP WAY STE 605
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6742
Practice Address - Country:US
Practice Address - Phone:972-335-8717
Practice Address - Fax:972-731-0264
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18-1141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26-1369628OtherEIN