Provider Demographics
NPI: | 1720376205 |
---|---|
Name: | JOHN D DAVIS D.D.S. |
Entity Type: | Organization |
Organization Name: | JOHN D DAVIS D.D.S. |
Other - Org Name: | DAVIS FAMILY DENTISTRY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | DAVIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 740-532-6520 |
Mailing Address - Street 1: | 1501 S 9TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | IRONTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45638-2225 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 740-532-6520 |
Mailing Address - Fax: | 740-532-9564 |
Practice Address - Street 1: | 1501 S 9TH ST |
Practice Address - Street 2: | |
Practice Address - City: | IRONTON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45638-2225 |
Practice Address - Country: | US |
Practice Address - Phone: | 740-532-6520 |
Practice Address - Fax: | 740-532-9564 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-07-18 |
Last Update Date: | 2011-07-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 30013864 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |