MEDICARE: ALPHONZO LOWELL DAVIDSON JR. 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	1223G0001X	General Practice Dentistry	5474	DC
2	1223G0001X	General Practice Dentistry	11379	MD

General Provider Information

NPI Number	:	1265574685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALPHONZO LOWELL DAVIDSON JR. D.D.S.

Provider Business Mailing Address
First Line	:	3308 SHORTRIDGE LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2576
Country	:	US
Telephone Number	:	202-528-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3865
Country	:	US
Telephone Number	:	202-584-0710
Fax Number	:	202-575-3627

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	12/22/2023

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