Provider Demographics
NPI:1760425144
Name:DAVIS, STEVEN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:H
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS PA
Mailing Address - Street 1:2810 WAKEFIELD PINES DR
Mailing Address - Street 2:STE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614
Mailing Address - Country:US
Mailing Address - Phone:919-488-2194
Mailing Address - Fax:919-488-2197
Practice Address - Street 1:2810 WAKEFIELD PINES DR
Practice Address - Street 2:STE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-488-2194
Practice Address - Fax:919-488-2197
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6219204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990050Medicaid
NC8990050Medicaid
2428684CMedicare ID - Type Unspecified