Provider Demographics
NPI:1558444950
Name:DAVIS, DEANNA (DMD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04628
Mailing Address - Country:US
Mailing Address - Phone:207-743-8786
Mailing Address - Fax:207-236-8380
Practice Address - Street 1:27 GREEN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268
Practice Address - Country:US
Practice Address - Phone:207-743-8786
Practice Address - Fax:207-236-8380
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME34771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice