Provider Demographics
NPI:1437296225
Name:DAVIS FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:DAVIS FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-784-3377
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:1002 MERIDIAN AVENUE
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-0248
Mailing Address - Country:US
Mailing Address - Phone:308-784-3377
Mailing Address - Fax:308-784-3395
Practice Address - Street 1:1002 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1757
Practice Address - Country:US
Practice Address - Phone:308-784-3377
Practice Address - Fax:308-784-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental