Provider Demographics
NPI:1457535700
Name:GREGORY DAVIS DDS INC.
Entity Type:Organization
Organization Name:GREGORY DAVIS DDS INC.
Other - Org Name:KEARNY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PARKE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-292-8180
Mailing Address - Street 1:4626 MERCURY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2410
Mailing Address - Country:US
Mailing Address - Phone:858-292-8180
Mailing Address - Fax:858-292-0690
Practice Address - Street 1:4626 MERCURY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2410
Practice Address - Country:US
Practice Address - Phone:858-292-8180
Practice Address - Fax:858-292-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty