Healthcare Provider Details

I. General information

NPI: 1790785103
Provider Name (Legal Business Name): DONALD BRIAN DAVIES D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10751 MONTGOMERY RD
CINCINNATI OH
45242-3256
US

IV. Provider business mailing address

10751 MONTGOMERY RD
CINCINNATI OH
45242-3256
US

V. Phone/Fax

Practice location:
  • Phone: 513-469-1121
  • Fax:
Mailing address:
  • Phone: 513-469-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number19547
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12471
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number35244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: