Provider Demographics
NPI:1710386255
Name:DAVIS, DAPHNE CAMILLE
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:CAMILLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4321
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-4321
Mailing Address - Country:US
Mailing Address - Phone:972-804-2162
Mailing Address - Fax:
Practice Address - Street 1:7722 CHORUS WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3562
Practice Address - Country:US
Practice Address - Phone:972-804-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor