Provider Demographics
NPI:1760449912
Name:DAVIDSON, AMY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ANN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:ANN
Other - Last Name:WOIOTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1460 COLE STREET
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009
Mailing Address - Country:US
Mailing Address - Phone:248-703-6022
Mailing Address - Fax:
Practice Address - Street 1:24901 KELLY ROAD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-772-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035512122300000X
MI29010194491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice