MEDICARE: WILLIAM R. DAVIDSON, D.D.S.& ASSOC., INC.

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	122300000X	Dentist	30-016734	OH

General Provider Information

NPI Number	:	1790998813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM R. DAVIDSON, D.D.S.& ASSOC., INC.

Provider Business Mailing Address
First Line	:	9365 OLDE 8 RD
Second Line	:
City	:	NORTHFIELD
State	:	OH
Zip	:	44067-2052
Country	:	US
Telephone Number	:	330-467-6066
Fax Number	:	330-467-0504

Provider Business Practice Location Address
First Line	:	9365 OLDE 8 RD
Second Line	:
City	:	NORTHFIELD
State	:	OH
Zip	:	44067-2052
Country	:	US
Telephone Number	:	330-467-6066
Fax Number	:	330-467-0504

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NANCY A DANIK
Credential	:
Telephone Number	:	330-467-6066

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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