Healthcare Provider Details

I. General information

NPI: 1508051889
Provider Name (Legal Business Name): BRIAN C. DAVIS D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2992 WALDORF MARKET PL
WALDORF MD
20603-4874
US

IV. Provider business mailing address

14625 BALTIMORE AVE STE 239
LAUREL MD
20707-4902
US

V. Phone/Fax

Practice location:
  • Phone: 301-843-9330
  • Fax:
Mailing address:
  • Phone: 202-341-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDEN5982
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number18922
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: