Provider Demographics
NPI:1770812869
Name:DAVIS, JOSHUA (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 WALNUT ST
Mailing Address - Street 2:518
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4017
Mailing Address - Country:US
Mailing Address - Phone:215-567-5949
Mailing Address - Fax:215-567-1517
Practice Address - Street 1:1420 WALNUT ST
Practice Address - Street 2:518
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4017
Practice Address - Country:US
Practice Address - Phone:215-567-5949
Practice Address - Fax:215-567-1517
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0380841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics