MEDICARE: ANTHONY LAMAR DAVIS DDS

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	1223G0001X	General Practice Dentistry	0401412732	VA
2	1223G0001X	General Practice Dentistry	DN19529	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184766545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY LAMAR DAVIS DDS

Provider Business Mailing Address
First Line	:	NBHC MAYPORT
Second Line	:	2104 MASSEY AVENUE, DENTAL DEPT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32228
Country	:	US
Telephone Number	:	904-270-4460
Fax Number	:

Provider Business Practice Location Address
First Line	:	NBHC MAYPORT
Second Line	:	2104 MASSEY AVENUE, DENTAL DEPT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32228
Country	:	US
Telephone Number	:	904-270-4460
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/09/2023

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