Provider Demographics
NPI:1568505733
Name:DAVIS, RICK JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:JAMES
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:436 FIVE GAITS CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1811
Mailing Address - Country:US
Mailing Address - Phone:989-493-5152
Mailing Address - Fax:
Practice Address - Street 1:436 FIVE GAITS CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-1811
Practice Address - Country:US
Practice Address - Phone:989-493-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice