Provider Demographics
NPI:1942547591
Name:DAVIS & O'CONNOR DENTAL CORPORATION
Entity Type:Organization
Organization Name:DAVIS & O'CONNOR DENTAL CORPORATION
Other - Org Name:OLIVE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-722-7789
Mailing Address - Street 1:3040 PARK AVENUE
Mailing Address - Street 2:SUITE H
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348
Mailing Address - Country:US
Mailing Address - Phone:209-722-7789
Mailing Address - Fax:209-722-7811
Practice Address - Street 1:3040 PARK AVENUE
Practice Address - Street 2:SUITE H
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-722-7789
Practice Address - Fax:209-722-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty