Provider Demographics
NPI:1790850170
Name:KEITH L. DAVIS, D.M.D.,LLC
Entity Type:Organization
Organization Name:KEITH L. DAVIS, D.M.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-678-2525
Mailing Address - Street 1:100 CHELSEA CORNERS WAY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-8208
Mailing Address - Country:US
Mailing Address - Phone:205-678-2525
Mailing Address - Fax:205-378-6474
Practice Address - Street 1:100 CHELSEA CORNERS WAY
Practice Address - Street 2:SUITE 113
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-8208
Practice Address - Country:US
Practice Address - Phone:205-678-2525
Practice Address - Fax:205-378-6474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty