Healthcare Provider Details

I. General information

NPI: 1942165360
Provider Name (Legal Business Name): INNOVATION DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 GILLIONVILLE RD
ALBANY GA
31707-3003
US

IV. Provider business mailing address

2607 GILLIONVILLE RD
ALBANY GA
31707-3003
US

V. Phone/Fax

Practice location:
  • Phone: 615-364-4273
  • Fax:
Mailing address:
  • Phone: 615-364-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY DENNIS DAVIS
Title or Position: OWNER
Credential: DDS
Phone: 615-364-4273