Healthcare Provider Details

I. General information

NPI: 1679338420
Provider Name (Legal Business Name): VICTORIA DAVIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA KEMYA CHLOE DAVIS DDS

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 MANHATTAN BLVD STE D
HARVEY LA
70058-4605
US

IV. Provider business mailing address

929 MANHATTAN BLVD STE D
HARVEY LA
70058-4605
US

V. Phone/Fax

Practice location:
  • Phone: 504-208-2904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7614
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: