Provider Demographics
NPI:1598932642
Name:DAVIS, NATHANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11219 COPPER SHORES LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1675
Mailing Address - Country:US
Mailing Address - Phone:313-618-1041
Mailing Address - Fax:
Practice Address - Street 1:19961 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1019
Practice Address - Country:US
Practice Address - Phone:713-244-7799
Practice Address - Fax:832-321-3766
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010143131223G0001X
TX231201223G0001X
MI5501001870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
N17040001Medicare PIN