Provider Demographics
NPI:1851602882
Name:DAVIS, LEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 W. BELT LINE RD STE100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146
Mailing Address - Country:US
Mailing Address - Phone:972-200-1589
Mailing Address - Fax:
Practice Address - Street 1:1370 W BELTLINE RD
Practice Address - Street 2:STE 100
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146
Practice Address - Country:US
Practice Address - Phone:972-200-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist