Provider Demographics
NPI:1770925430
Name:MICHELLE K DAVIS, DMD PC
Entity type:Organization
Organization Name:MICHELLE K DAVIS, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-699-8583
Mailing Address - Street 1:7800 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-2119
Mailing Address - Country:US
Mailing Address - Phone:205-699-8583
Mailing Address - Fax:205-699-4809
Practice Address - Street 1:7800 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-2119
Practice Address - Country:US
Practice Address - Phone:205-699-8583
Practice Address - Fax:205-699-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty