Provider Demographics
NPI:1609907427
Name:DAVIS, ROGER FRANKLIN SR (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:FRANKLIN
Last Name:DAVIS
Suffix:SR
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 1:202 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2947
Mailing Address - Country:US
Mailing Address - Phone:863-763-2765
Mailing Address - Fax:863-763-9112
Practice Address - Street 1:202 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2947
Practice Address - Country:US
Practice Address - Phone:863-763-2765
Practice Address - Fax:863-763-9112
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0051091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice