Provider Demographics
NPI:1952443921
Name:TANZANIA DAVIS, DDS, PC
Entity Type:Organization
Organization Name:TANZANIA DAVIS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANZANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-262-0800
Mailing Address - Street 1:3231 SUPERIOR LN
Mailing Address - Street 2:SUITE A-22
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1923
Mailing Address - Country:US
Mailing Address - Phone:301-262-0800
Mailing Address - Fax:301-262-7832
Practice Address - Street 1:3231 SUPERIOR LN
Practice Address - Street 2:SUITE A-22
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1923
Practice Address - Country:US
Practice Address - Phone:301-262-0800
Practice Address - Fax:301-262-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty