MEDICARE: MARK M 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	1223G0001X	General Practice Dentistry	4353	OK

General Provider Information

NPI Number	:	1982613824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK M DAVIS DDS

Provider Business Mailing Address
First Line	:	5301 S LEWIS AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-6539
Country	:	US
Telephone Number	:	918-742-8100
Fax Number	:	918-742-8159

Provider Business Practice Location Address
First Line	:	5301 S LEWIS AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-6539
Country	:	US
Telephone Number	:	918-742-8100
Fax Number	:	918-742-8159

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	05/30/2015

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