Provider Demographics
NPI:1942673496
Name:DAVEY DENTAL CORPORATION
Entity Type:Organization
Organization Name:DAVEY DENTAL CORPORATION
Other - Org Name:DEL SUR RANCH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-759-2700
Mailing Address - Street 1:1640 PASEO DEL SUR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127
Mailing Address - Country:US
Mailing Address - Phone:858-759-2700
Mailing Address - Fax:
Practice Address - Street 1:1640 PASEO DEL SUR
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127
Practice Address - Country:US
Practice Address - Phone:858-759-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty