Provider Demographics
NPI:1497973960
Name:DAVIDSON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DAVIDSON FAMILY DENTISTRY
Other - Org Name:DR DAVID DAVIDSON
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-279-3848
Mailing Address - Street 1:8573 URBANDALE AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322
Mailing Address - Country:US
Mailing Address - Phone:515-279-3848
Mailing Address - Fax:515-279-4479
Practice Address - Street 1:8573 URBANDALE AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:515-279-3848
Practice Address - Fax:515-279-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA65571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA170589OtherDELTA DENTAL OF IA
IA0005207Medicaid
IA4007496OtherWELLMARK BLUE DENTAL