Provider Demographics
NPI:1598094740
Name:DAVIS, TANZANIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANZANIA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 SUPERIOR LN
Mailing Address - Street 2:SUITE A-22
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1923
Mailing Address - Country:US
Mailing Address - Phone:301-262-0800
Mailing Address - Fax:301-262-7832
Practice Address - Street 1:3231 SUPERIOR LN
Practice Address - Street 2:SUITE A-22
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1923
Practice Address - Country:US
Practice Address - Phone:301-262-0800
Practice Address - Fax:301-262-7832
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist