MEDICARE: DR. RUSSELL LEROY 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	1223G0001X	General Practice Dentistry	23436	CA

General Provider Information

NPI Number	:	1285766410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL LEROY DAVIS D.D.S.

Provider Business Mailing Address
First Line	:	950 I ST
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-6158
Country	:	US
Telephone Number	:	707-822-0525
Fax Number	:	707-822-0500

Provider Business Practice Location Address
First Line	:	950 I ST
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-6158
Country	:	US
Telephone Number	:	707-822-0525
Fax Number	:	707-822-0500

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	01/18/2026

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Directions to “ DR. RUSSELL LEROY DAVIS D.D.S.” Practice Location

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