Provider Demographics
NPI:1568426062
Name:DAVIS, ROBERT S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:M
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:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:VALLEY FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:19482-0728
Mailing Address - Country:US
Mailing Address - Phone:610-933-4482
Mailing Address - Fax:610-933-3905
Practice Address - Street 1:1288 VALLEY FORGE ROAD
Practice Address - Street 2:SUITE 52
Practice Address - City:VALLEY FORGE
Practice Address - State:PA
Practice Address - Zip Code:19482-0728
Practice Address - Country:US
Practice Address - Phone:610-933-4482
Practice Address - Fax:610-933-3905
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018622L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice