Provider Demographics
NPI:1609200351
Name:DAVIS, JANEL (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JANEL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32115
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2115
Mailing Address - Country:US
Mailing Address - Phone:907-957-4330
Mailing Address - Fax:
Practice Address - Street 1:709 W 9TH ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1807
Practice Address - Country:US
Practice Address - Phone:907-463-2140
Practice Address - Fax:907-463-2150
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK740124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist