Provider Demographics
NPI:1275914392
Name:DAVIS, MARY KATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 EP TRUE PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7000
Mailing Address - Country:US
Mailing Address - Phone:515-224-1618
Mailing Address - Fax:
Practice Address - Street 1:1903 EP TRUE PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-7000
Practice Address - Country:US
Practice Address - Phone:515-224-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist