Provider Demographics
NPI:1922185107
Name:DAVIDSON, HENRY BRADLEY IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:BRADLEY
Last Name:DAVIDSON
Suffix:IV
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 1:68 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3917
Mailing Address - Country:US
Mailing Address - Phone:315-252-7278
Mailing Address - Fax:315-252-7279
Practice Address - Street 1:68 SOUTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3917
Practice Address - Country:US
Practice Address - Phone:315-252-7278
Practice Address - Fax:315-252-7279
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0314161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice