Provider Demographics
NPI:1649630757
Name:DEANNA L DAVIS DDS PLLC
Entity type:Organization
Organization Name:DEANNA L DAVIS DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-817-2966
Mailing Address - Street 1:13207 BROAD BAY LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-6707
Mailing Address - Country:US
Mailing Address - Phone:713-817-2966
Mailing Address - Fax:
Practice Address - Street 1:12810 BROADWAY ST. STE
Practice Address - Street 2:110
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-6707
Practice Address - Country:US
Practice Address - Phone:713-817-2966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty