Provider Demographics
NPI:1821301599
Name:ALPHONZO L. DAVIDSON SR,D.D.S.,PA
Entity Type:Organization
Organization Name:ALPHONZO L. DAVIDSON SR,D.D.S.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL MAXILLOFACIAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ALPHONZO
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS,PA
Authorized Official - Phone:301-322-8900
Mailing Address - Street 1:932 LARGO CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-3704
Mailing Address - Country:US
Mailing Address - Phone:301-322-8900
Mailing Address - Fax:301-322-2840
Practice Address - Street 1:932 LARGO CENTER DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3704
Practice Address - Country:US
Practice Address - Phone:301-322-8900
Practice Address - Fax:301-322-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD53421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty