Provider Demographics
NPI:1457656506
Name:DAVIS, WILLIAM R
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7398 WOODMONT CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3209
Mailing Address - Country:US
Mailing Address - Phone:561-479-0947
Mailing Address - Fax:561-829-7252
Practice Address - Street 1:7398 WOODMONT CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3209
Practice Address - Country:US
Practice Address - Phone:561-479-0947
Practice Address - Fax:561-829-7252
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN6331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist