Provider Demographics
NPI:1982108759
Name:DANIELLE DAVIS LLC
Entity Type:Organization
Organization Name:DANIELLE DAVIS LLC
Other - Org Name:901 DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:901-235-0709
Mailing Address - Street 1:9775 HIGHWAY 64 STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8587
Mailing Address - Country:US
Mailing Address - Phone:901-235-0709
Mailing Address - Fax:
Practice Address - Street 1:9775 HIGHWAY 64 STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-8587
Practice Address - Country:US
Practice Address - Phone:512-663-7611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty