Provider Demographics
NPI:1982805602
Name:DAVIES, ROLAND STEPHEN (DOCTOR OF DENTISTRY)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:STEPHEN
Last Name:DAVIES
Suffix:
Gender:M
Credentials:DOCTOR OF DENTISTRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 EXPOSITION BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703
Mailing Address - Country:US
Mailing Address - Phone:512-474-7356
Mailing Address - Fax:512-474-7357
Practice Address - Street 1:2630 EXPOSITION BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703
Practice Address - Country:US
Practice Address - Phone:512-474-7356
Practice Address - Fax:512-474-7357
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist