Provider Demographics
NPI:1205106945
Name:TOM DAVIES, D.D.S., LLC
Entity type:Organization
Organization Name:TOM DAVIES, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-519-5712
Mailing Address - Street 1:3688 WRENCOE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-6383
Mailing Address - Country:US
Mailing Address - Phone:760-519-5712
Mailing Address - Fax:888-222-6516
Practice Address - Street 1:103 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1394
Practice Address - Country:US
Practice Address - Phone:760-519-5712
Practice Address - Fax:888-222-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4403261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental