Provider Demographics
NPI:1962456236
Name:DAVIES, JONATHAN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:F
Last Name:DAVIES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 SMITH ROAD ATTN: PROFESSIONAL AFFAIRS
Mailing Address - Street 2:NAVAL HEALTH CARE NEW ENGLAND
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02841-1002
Mailing Address - Country:US
Mailing Address - Phone:401-841-4522
Mailing Address - Fax:401-841-4128
Practice Address - Street 1:650 SEWALL STREET
Practice Address - Street 2:BRANCH HEALTH CLINIC NAVAL AIR STATION
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-921-1820
Practice Address - Fax:207-921-2992
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME2631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN