Provider Demographics
NPI:1578200010
Name:JEFFREY S DAVIS DDS LTD
Entity Type:Organization
Organization Name:JEFFREY S DAVIS DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYOR RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-916-9000
Mailing Address - Street 1:2270 VALOR DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6105
Mailing Address - Country:US
Mailing Address - Phone:540-545-7878
Mailing Address - Fax:865-675-4719
Practice Address - Street 1:2270 VALOR DR STE 105
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6105
Practice Address - Country:US
Practice Address - Phone:540-545-7878
Practice Address - Fax:865-675-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty