Healthcare Provider Details

I. General information

NPI: 1184649618
Provider Name (Legal Business Name): STEPHEN BOYD DAVIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

507 OREGON ST
EL SEGUNDO CA
90245-3237
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-5407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number27420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: