Provider Demographics
NPI:1952427684
Name:DAVIS, BRYAN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:E
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 1:629 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3518
Mailing Address - Country:US
Mailing Address - Phone:626-915-8744
Mailing Address - Fax:626-915-8746
Practice Address - Street 1:629 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3518
Practice Address - Country:US
Practice Address - Phone:626-915-8744
Practice Address - Fax:626-915-8746
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA510571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice