Provider Demographics
NPI:1316029747
Name:DAVIS, WILLIAM T (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3707
Mailing Address - Country:US
Mailing Address - Phone:843-361-0500
Mailing Address - Fax:843-361-0515
Practice Address - Street 1:1240 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3707
Practice Address - Country:US
Practice Address - Phone:843-361-0500
Practice Address - Fax:843-361-0515
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC36221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice