Healthcare Provider Details

I. General information

NPI: 1235506601
Provider Name (Legal Business Name): MALCOLM DAVIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 S ACADEMY BLVD
COLORADO SPRINGS CO
80916-2408
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 313-673-2318
  • Fax:
Mailing address:
  • Phone: 313-673-2318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD.007315
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00204322
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTD-00-129
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD011217
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: