MEDICARE: DR. FREDRIC COOPER DAVIS DMD

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	F-22014	TX

General Provider Information

NPI Number	:	1396052494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDRIC COOPER DAVIS DMD

Provider Business Mailing Address
First Line	:	3410 TAFT BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2036
Country	:	US
Telephone Number	:	940-397-4738
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 TAFT BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2036
Country	:	US
Telephone Number	:	940-397-4738
Fax Number	:

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

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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