Provider Demographics
NPI:1700943883
Name:DAVIDSON, ALPHONZO LOWELL SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALPHONZO
Middle Name:LOWELL
Last Name:DAVIDSON
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 LARGO CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:301-322-8900
Mailing Address - Fax:301-322-2840
Practice Address - Street 1:932 LARGO CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-322-8900
Practice Address - Fax:301-322-8900
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD53421223S0112X
DCDEN25241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD016704500Medicaid
DC021605300Medicaid
MD521014779OtherTIN
DC021605300Medicaid