Provider Demographics
NPI:1437218559
Name:DAVIS, NATHAN T (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 S POWER RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209
Mailing Address - Country:US
Mailing Address - Phone:480-969-8500
Mailing Address - Fax:480-969-8503
Practice Address - Street 1:2500 S POWER RD
Practice Address - Street 2:SUITE 128
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-969-8500
Practice Address - Fax:480-969-8503
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ49141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics