Provider Demographics
NPI:1720376205
Name:JOHN D DAVIS D.D.S.
Entity Type:Organization
Organization Name:JOHN D DAVIS D.D.S.
Other - Org Name:DAVIS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-532-6520
Mailing Address - Street 1:1501 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2225
Mailing Address - Country:US
Mailing Address - Phone:740-532-6520
Mailing Address - Fax:740-532-9564
Practice Address - Street 1:1501 S 9TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2225
Practice Address - Country:US
Practice Address - Phone:740-532-6520
Practice Address - Fax:740-532-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30013864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty