Provider Demographics
NPI:1578638177
Name:DAVIS, ISAAC E III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:E
Last Name:DAVIS
Suffix:III
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 1:7033 SAINT ANDREWS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1179
Mailing Address - Country:US
Mailing Address - Phone:803-781-3321
Mailing Address - Fax:803-781-4406
Practice Address - Street 1:7033 SAINT ANDREWS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1179
Practice Address - Country:US
Practice Address - Phone:803-781-3321
Practice Address - Fax:803-781-4406
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ27044Medicaid
SC2704OtherDENTAL LICENSE
SC2704OtherDENTAL LICENSE
SCU43875Medicare UPIN