Healthcare Provider Details

I. General information

NPI: 1215052378
Provider Name (Legal Business Name): WANDA L DAVIDSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 K ST NW SUITE 15B
WASHINGTON DC
20006-1103
US

IV. Provider business mailing address

1990 K ST NW SUITE 15B
WASHINGTON DC
20006-1103
US

V. Phone/Fax

Practice location:
  • Phone: 202-775-0022
  • Fax:
Mailing address:
  • Phone: 202-775-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDEN1000212
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: