Healthcare Provider Details

I. General information

NPI: 1669528998
Provider Name (Legal Business Name): DR. BRIAN G DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9918 HOLMES RD STE B
KANSAS CITY MO
64131-4306
US

IV. Provider business mailing address

9918 HOLMES RD STE B
KANSAS CITY MO
64131-4306
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-0003
  • Fax: 816-943-0034
Mailing address:
  • Phone: 816-943-0003
  • Fax: 816-943-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2004033307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: