Provider Demographics
NPI:1790979789
Name:DAVIS, ADAM (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W CALDWELL ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2910
Mailing Address - Country:US
Mailing Address - Phone:615-758-7668
Mailing Address - Fax:615-758-7667
Practice Address - Street 1:40 W CALDWELL ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-2910
Practice Address - Country:US
Practice Address - Phone:615-758-7668
Practice Address - Fax:615-758-7667
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-01
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics