Provider Demographics
NPI:1528398179
Name:DAVIS, ALLAN REX (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:REX
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 E DANA DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7599
Mailing Address - Country:US
Mailing Address - Phone:360-426-1576
Mailing Address - Fax:
Practice Address - Street 1:531 E DANA DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-7599
Practice Address - Country:US
Practice Address - Phone:360-426-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist