Provider Demographics
NPI:1679517163
Name:DAVIS, ROMONA L (DDS)
Entity Type:Individual
Prefix:
First Name:ROMONA
Middle Name:L
Last Name: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 1:2475 W PECOS RD
Mailing Address - Street 2:#2095
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4807
Mailing Address - Country:US
Mailing Address - Phone:210-452-8665
Mailing Address - Fax:
Practice Address - Street 1:2900 W RAY RD
Practice Address - Street 2:SUITE #2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-7342
Practice Address - Country:US
Practice Address - Phone:480-782-5437
Practice Address - Fax:480-857-7888
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20030122300000X
AZ70861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7086OtherARIZONA DENTAL LICENSE
TX20030OtherTEXAS DENTAL LICENSE