Provider Demographics
NPI:1932380250
Name:DAVIS, RUSTY KIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSTY
Middle Name:KIP
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3648
Mailing Address - Country:US
Mailing Address - Phone:540-943-2723
Mailing Address - Fax:540-943-1419
Practice Address - Street 1:400 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3648
Practice Address - Country:US
Practice Address - Phone:540-943-2723
Practice Address - Fax:540-943-1419
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95351223G0001X
VA04014118201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice