MEDICARE: DR. MICHAEL SCOT DAVIS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	27038	TX
2	1223G0001X	General Practice Dentistry	27038	TX

General Provider Information

NPI Number	:	1003103920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SCOT DAVIS D.D.S.

Provider Business Mailing Address
First Line	:	1302 S GEN MCMULLEN DR
Second Line	:	SUITE 102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-4200
Country	:	US
Telephone Number	:	210-432-7851
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 S GEN MCMULLEN DR
Second Line	:	SUITE 102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-4200
Country	:	US
Telephone Number	:	210-432-7851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	05/26/2021

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