Provider Demographics
NPI:1265574685
Name:DAVIDSON, ALPHONZO LOWELL JR (DDS)
Entity type:Individual
Prefix:
First Name:ALPHONZO
Middle Name:LOWELL
Last Name:DAVIDSON
Suffix:JR
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 1:3308 SHORTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2576
Mailing Address - Country:US
Mailing Address - Phone:202-528-0440
Mailing Address - Fax:
Practice Address - Street 1:2811 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3865
Practice Address - Country:US
Practice Address - Phone:202-584-0710
Practice Address - Fax:202-575-3627
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC54741223G0001X
MD113791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice