Provider Demographics
NPI:1336267384
Name:DAVIDSON, DANIEL GORDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GORDON
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2605
Mailing Address - Country:US
Mailing Address - Phone:415-239-2740
Mailing Address - Fax:415-334-0671
Practice Address - Street 1:2375 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-2605
Practice Address - Country:US
Practice Address - Phone:415-239-2740
Practice Address - Fax:415-334-0671
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice