Provider Demographics
NPI:1265595029
Name:DAVIS, GUY GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:GEORGE
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 1:2627 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-4429
Mailing Address - Country:US
Mailing Address - Phone:209-462-9300
Mailing Address - Fax:209-462-9313
Practice Address - Street 1:2627 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-4429
Practice Address - Country:US
Practice Address - Phone:209-462-9300
Practice Address - Fax:209-462-9313
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice