Provider Demographics
NPI:1013490218
Name:DAVIS, JOHN PHILIP MCKENZIE (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN PHILIP
Middle Name:MCKENZIE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-4726
Mailing Address - Country:US
Mailing Address - Phone:870-879-4870
Mailing Address - Fax:
Practice Address - Street 1:4100 W 28TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-4726
Practice Address - Country:US
Practice Address - Phone:870-879-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist