Provider Demographics
NPI:1376746024
Name:DAVIS, JEAN-PAUL W (DDS, MSC)
Entity Type:Individual
Prefix:DR
First Name:JEAN-PAUL
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20524 VENTURA BLVD APT 108
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6218
Mailing Address - Country:US
Mailing Address - Phone:818-598-0718
Mailing Address - Fax:
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:SUITE #251
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4233
Practice Address - Country:US
Practice Address - Phone:818-345-5286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery