Provider Demographics
NPI:1356547780
Name:DARRELL W. DAVIS, D.D.S., P.C
Entity type:Organization
Organization Name:DARRELL W. DAVIS, D.D.S., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:816-350-7710
Mailing Address - Street 1:17020 E. U.S. HIGHWAY 40
Mailing Address - Street 2:#7
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64014-5365
Mailing Address - Country:US
Mailing Address - Phone:816-350-7710
Mailing Address - Fax:816-350-7711
Practice Address - Street 1:17020 E US HIGHWAY 40
Practice Address - Street 2:#7
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5361
Practice Address - Country:US
Practice Address - Phone:816-350-7710
Practice Address - Fax:816-350-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1750430955OtherNPI TYPE 1