Provider Demographics
NPI:1659625903
Name:DAVIS, FRANKLIN BRENT (D M D)
Entity Type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:BRENT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 OGLETHORPE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1703
Mailing Address - Country:US
Mailing Address - Phone:478-743-5856
Mailing Address - Fax:478-745-7953
Practice Address - Street 1:1248 OGLETHORPE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1703
Practice Address - Country:US
Practice Address - Phone:478-743-5856
Practice Address - Fax:478-745-7953
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist