Provider Demographics
NPI:1760898746
Name:DAVIS, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
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 1:11627 STATE ROUTE 243
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-7962
Mailing Address - Country:US
Mailing Address - Phone:740-867-6641
Mailing Address - Fax:740-867-9626
Practice Address - Street 1:11627 STATE ROUTE 243
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-7962
Practice Address - Country:US
Practice Address - Phone:740-867-6641
Practice Address - Fax:740-867-9626
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6986124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist