Healthcare Provider Details

I. General information

NPI: 1982916490
Provider Name (Legal Business Name): STEPHEN DOUGLAS DAVIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 STAR RANCH RD
COLORADO SPRINGS CO
80906-5980
US

IV. Provider business mailing address

3605 STAR RANCH RD STE A
COLORADO SPRINGS CO
80906-5980
US

V. Phone/Fax

Practice location:
  • Phone: 719-576-3276
  • Fax:
Mailing address:
  • Phone: 719-576-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9451
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10723
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: