Healthcare Provider Details

I. General information

NPI: 1932237310
Provider Name (Legal Business Name): DAVIS FAMILY DENTAL, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
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 ROAD, SUITE B
KANSAS CITY MO
64131
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 Code305R00000X
TaxonomyPreferred Provider Organization
License Number2004033307
License Number StateMO

VIII. Authorized Official

Name: DR. BRIAN G DAVIS
Title or Position: DENTIST
Credential: D.D.S.
Phone: 816-943-0003