Provider Demographics
NPI:1871816389
Name:DAVIS, JAMES WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 W ILES AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4190
Mailing Address - Country:US
Mailing Address - Phone:217-787-6761
Mailing Address - Fax:217-787-6611
Practice Address - Street 1:2025 W ILES AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4190
Practice Address - Country:US
Practice Address - Phone:217-787-6761
Practice Address - Fax:217-787-6611
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0012941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1649342999OtherCORPORATE NPI