Provider Demographics
NPI:1356639876
Name:DO, DAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:
Last Name:DO
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 1:11235 LEE WAY APT 15102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3070
Mailing Address - Country:US
Mailing Address - Phone:626-380-7626
Mailing Address - Fax:
Practice Address - Street 1:4110 W POINT LOMA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5603
Practice Address - Country:US
Practice Address - Phone:619-701-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
126800000X
CA101970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No126800000XDental ProvidersDental Assistant