Healthcare Provider Details

I. General information

NPI: 1376746024
Provider Name (Legal Business Name): JEAN-PAUL W DAVIS DDS, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18399 VENTURA BLVD SUITE #251
TARZANA CA
91356-4233
US

IV. Provider business mailing address

20524 VENTURA BLVD APT 108
WOODLAND HILLS CA
91364-6218
US

V. Phone/Fax

Practice location:
  • Phone: 818-345-5286
  • Fax:
Mailing address:
  • Phone: 818-598-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number54578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: