Provider Demographics
NPI:1417163221
Name:KATHY L DAVIES, DDS, MS, PA
Entity Type:Organization
Organization Name:KATHY L DAVIES, DDS, MS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-967-5099
Mailing Address - Street 1:900 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:(HISTORIC AIRPORT ROAD)SUITE B
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2601
Mailing Address - Country:US
Mailing Address - Phone:919-967-5099
Mailing Address - Fax:919-932-6098
Practice Address - Street 1:900 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:(HISTORIC AIRPORT ROAD)SUITE B
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2601
Practice Address - Country:US
Practice Address - Phone:919-967-5099
Practice Address - Fax:919-932-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720087455OtherINDIVIDUAL NPI