Provider Demographics
NPI:1710465687
Name:DAVIS, ALYSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALYSE
Middle Name:
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 1:5055 VON SCHEELE DR APT 1436
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4358
Mailing Address - Country:US
Mailing Address - Phone:830-329-2511
Mailing Address - Fax:
Practice Address - Street 1:23535 W IH 10 STE 2202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1673
Practice Address - Country:US
Practice Address - Phone:210-687-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice