Healthcare Provider Details

I. General information

NPI: 1962701946
Provider Name (Legal Business Name): J. PATRICK DAVIS & MATTHEW DAVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL STE B203
ENCINITAS CA
92024-1353
US

IV. Provider business mailing address

477 N EL CAMINO REAL STE B203
ENCINITAS CA
92024-1353
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-1131
  • Fax: 760-942-4868
Mailing address:
  • Phone: 760-942-1131
  • Fax: 760-942-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number26834
License Number StateCA

VIII. Authorized Official

Name: MR. J. PATRICK DAVIS
Title or Position: OWNER/DENTIST
Credential: DDS, MS
Phone: 760-942-1131