MEDICARE: MICHAEL R. 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	1223P0221X	Pediatric Dentistry	30.026399	OH
2	1223P0221X	Pediatric Dentistry	0401417779	VA

General Provider Information

NPI Number	:	1780218511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R. DAVIS DDS

Provider Business Mailing Address
First Line	:	2400 COLONY CROSSING PL
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-4281
Country	:	US
Telephone Number	:	727-623-8077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 COLONY CROSSING PL
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-4281
Country	:	US
Telephone Number	:	727-623-8077
Fax Number	:

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

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	10/24/2024

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