Healthcare Provider Details

I. General information

NPI: 1801018429
Provider Name (Legal Business Name): JOHN CHRISTIAN DAVIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 3RD ST W
RANDOLPH AFB TX
78150-4800
US

IV. Provider business mailing address

76 NEALY BLVD
LANGLEY AFB VA
23665-2022
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-1837
  • Fax:
Mailing address:
  • Phone: 757-225-5865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21054
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: