Provider Demographics
NPI:1952512436
Name:GEORGE A. DAVIS, JR., D.D.S., P.C.
Entity Type:Organization
Organization Name:GEORGE A. DAVIS, JR., D.D.S., P.C.
Other - Org Name:GLENDORA DENTAL SURGERY CENTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-852-9500
Mailing Address - Street 1:906 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4808
Mailing Address - Country:US
Mailing Address - Phone:626-852-9500
Mailing Address - Fax:
Practice Address - Street 1:906 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4808
Practice Address - Country:US
Practice Address - Phone:626-852-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty