Provider Demographics
NPI:1891833034
Name:DAVIS, LEONARD ERNEST JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ERNEST
Last Name:DAVIS
Suffix:JR
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:PO BOX 30818
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0818
Mailing Address - Country:US
Mailing Address - Phone:843-763-8755
Mailing Address - Fax:
Practice Address - Street 1:8325 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2231
Practice Address - Country:US
Practice Address - Phone:313-894-0000
Practice Address - Fax:313-894-0001
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22261223G0001X
MI2901008368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist