Healthcare Provider Details

I. General information

NPI: 1083609838
Provider Name (Legal Business Name): RONALD V DAVIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FOUR MILE DR STE 6
KALISPELL MT
59901-2631
US

IV. Provider business mailing address

40 FOUR MILE DR STE 6
KALISPELL MT
59901-2631
US

V. Phone/Fax

Practice location:
  • Phone: 406-755-6116
  • Fax:
Mailing address:
  • Phone: 406-755-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6133
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number105752
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2211
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: