Healthcare Provider Details

I. General information

NPI: 1013124171
Provider Name (Legal Business Name): STEVEN H. DAVIS, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 WAKEFIELD PINES DR SUITE 100
RALEIGH NC
27614-7078
US

IV. Provider business mailing address

2810 WAKEFIELD PINES DR SUITE 100
RALEIGH NC
27614-7078
US

V. Phone/Fax

Practice location:
  • Phone: 919-488-2194
  • Fax: 919-488-2197
Mailing address:
  • Phone: 919-488-2194
  • Fax: 919-488-2197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6219
License Number StateNC

VIII. Authorized Official

Name: DR. STEVEN H. DAVIS
Title or Position: PRESIDENT
Credential: DDS
Phone: 919-488-2194