Provider Demographics
NPI:1326040288
Name:DAVIS, RICHARD D (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1130 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4235
Mailing Address - Country:US
Mailing Address - Phone:210-405-0473
Mailing Address - Fax:210-490-7699
Practice Address - Street 1:1130 E SONTERRA BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4235
Practice Address - Country:US
Practice Address - Phone:210-405-0473
Practice Address - Fax:210-490-7699
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175551223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics