Healthcare Provider Details

I. General information

NPI: 1912183146
Provider Name (Legal Business Name): DENNIS S. DAVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 N LINCOLN AVE
LOVELAND CO
80537-4876
US

IV. Provider business mailing address

903 N LINCOLN AVE
LOVELAND CO
80537-4876
US

V. Phone/Fax

Practice location:
  • Phone: 970-667-1910
  • Fax: 970-667-1914
Mailing address:
  • Phone: 970-667-1910
  • Fax: 970-667-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number5960
License Number StateCO

VIII. Authorized Official

Name: DENNIS SAMUEL DAVIS
Title or Position: PRESIDENT
Credential: DC
Phone: 970-667-1910