Healthcare Provider Details

I. General information

NPI: 1306390653
Provider Name (Legal Business Name): RICHARD E. DAVIES D.D.S., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N SEQUIM AVE
SEQUIM WA
98382-3457
US

IV. Provider business mailing address

PO BOX 1116
SEQUIM WA
98382-4318
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-4850
  • Fax: 360-681-3966
Mailing address:
  • Phone: 360-683-4850
  • Fax: 360-681-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDE00004841
License Number StateWA

VIII. Authorized Official

Name: DR. RICHARD E. DAVIES
Title or Position: PRESIDENT
Credential:
Phone: 360-683-4850