Provider Demographics
NPI:1811081060
Name:DAVIDSON, JOEL D (DMD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 TOLLAND STAGE RD
Mailing Address - Street 2:PO BOX 887
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2924
Mailing Address - Country:US
Mailing Address - Phone:860-872-8551
Mailing Address - Fax:860-871-7758
Practice Address - Street 1:630 TOLLAND STAGE RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2924
Practice Address - Country:US
Practice Address - Phone:860-872-8551
Practice Address - Fax:860-871-7758
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist