Provider Demographics
NPI:1679649016
Name:DAVIS, JEFFREY SHAWN (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SHAWN
Last Name:DAVIS
Suffix:
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 1:2270 VALOR DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-545-7878
Mailing Address - Fax:540-301-0754
Practice Address - Street 1:2270 VALOR DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-545-7878
Practice Address - Fax:540-301-0754
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21652122300000X
VA0401005502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1643475OtherUNITED CONCORDIA
TX170115301Medicaid