Provider Demographics
NPI:1912095134
Name:DAVIS, CHARLES A (DDSMS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:716 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4506
Mailing Address - Country:US
Mailing Address - Phone:520-326-8516
Mailing Address - Fax:520-326-1013
Practice Address - Street 1:716 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4506
Practice Address - Country:US
Practice Address - Phone:520-326-8516
Practice Address - Fax:520-326-1013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ18811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ082868OtherSTATE AHCCCS NUMBER
AZ564721OtherUNITED CONCORDIA NUMBER
AZ082868OtherSTATE AHCCCS NUMBER