Provider Demographics
NPI:1952495145
Name:DAVIS, BRETT (DMD, PC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MUZZEY ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5226
Mailing Address - Country:US
Mailing Address - Phone:781-862-1767
Mailing Address - Fax:781-860-9841
Practice Address - Street 1:27 MUZZEY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5226
Practice Address - Country:US
Practice Address - Phone:781-862-1767
Practice Address - Fax:781-860-9841
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice