Provider Demographics
NPI:1487827275
Name:DAVIDSON, BO M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BO
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:8685 MARTIN WAY SE STE 101
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516
Mailing Address - Country:US
Mailing Address - Phone:360-489-1406
Mailing Address - Fax:360-491-1270
Practice Address - Street 1:8685 MARTIN WAY E STE 101
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516
Practice Address - Country:US
Practice Address - Phone:360-489-1406
Practice Address - Fax:360-491-1270
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADE601128681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry