MEDICARE: DAVIS & DOLD DENTAL, LLC

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	60684	KS

General Provider Information

NPI Number	:	1295286474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS & DOLD DENTAL, LLC

Provider Business Mailing Address
First Line	:	7570 W 21ST ST N STE 1050B
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1772
Country	:	US
Telephone Number	:	316-721-2024
Fax Number	:	316-721-9189

Provider Business Practice Location Address
First Line	:	7570 W 21ST ST N STE 1050B
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1772
Country	:	US
Telephone Number	:	316-721-2024
Fax Number	:	316-721-9189

Authorized Official
Title or Position	:	MEMBER
Name	:	JOSHUA W DAVIS
Credential	:	DDS
Telephone Number	:	316-721-2024

Provider Enumeration Date	:	10/21/2016
Last Update Date	:	01/16/2017

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Directions to “DAVIS & DOLD DENTAL, LLC ” Practice Location

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