Provider Demographics
NPI:1952475378
Name:DAVIS, JAMES LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 W CANDLETREE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8508
Mailing Address - Country:US
Mailing Address - Phone:309-692-6206
Mailing Address - Fax:309-692-6244
Practice Address - Street 1:1318 W CANDLETREE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8508
Practice Address - Country:US
Practice Address - Phone:309-692-6206
Practice Address - Fax:309-692-6244
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice