Healthcare Provider Details

I. General information

NPI: 1326645227
Provider Name (Legal Business Name): MATTHEW DAVIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA DENTAC FORT IRWIN, 390 NORTH LOOP RD
FORT IRWIN CA
92310
US

IV. Provider business mailing address

USA DENTAC FORT CAVAZOS, 36000 SHOEMAKER LANE SUITE 1051
FORT CAVAZOS TX
76544
US

V. Phone/Fax

Practice location:
  • Phone: 760-383-5289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38364
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: