Provider Demographics
NPI:1457349045
Name:DAVIS, GEOFFREY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:A
Last Name:DAVIS
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 1:581 BOYLSTON ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3608
Mailing Address - Country:US
Mailing Address - Phone:617-353-1500
Mailing Address - Fax:617-437-8406
Practice Address - Street 1:581 BOYLSTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3608
Practice Address - Country:US
Practice Address - Phone:617-353-1500
Practice Address - Fax:617-437-8406
Is Sole Proprietor?:No
Enumeration Date:2005-10-08
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist