Provider Demographics
NPI:1669024642
Name:MASSAQUOI DAVIS, SIATTA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIATTA
Middle Name:
Last Name:MASSAQUOI 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 1:2157 LOOKOUT CT
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2817
Mailing Address - Country:US
Mailing Address - Phone:817-368-3498
Mailing Address - Fax:
Practice Address - Street 1:8090 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7676
Practice Address - Country:US
Practice Address - Phone:817-428-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist