Provider Demographics
NPI:1437484938
Name:DAVIS, DEMETRESS LATRICE (DDS MDS)
Entity Type:Individual
Prefix:
First Name:DEMETRESS
Middle Name:LATRICE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 SILAS DEANE HWY STE 206A
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2339
Mailing Address - Country:US
Mailing Address - Phone:860-529-1000
Mailing Address - Fax:860-900-0049
Practice Address - Street 1:2139 SILAS DEANE HWY STE 206A
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2339
Practice Address - Country:US
Practice Address - Phone:860-529-1000
Practice Address - Fax:860-900-0049
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0392741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics