Provider Demographics
NPI:1669491338
Name:DAVIS, JAMES ROBERT II (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:DAVIS
Suffix:II
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 1:210 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2032
Mailing Address - Country:US
Mailing Address - Phone:574-259-5144
Mailing Address - Fax:
Practice Address - Street 1:210 S RACE ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2032
Practice Address - Country:US
Practice Address - Phone:574-259-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice