Healthcare Provider Details

I. General information

NPI: 1962592386
Provider Name (Legal Business Name): JOHN BYRNSIDE DAVIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 98 MEDWOOD PLAZA SUITE 302
NUTTER FORT WV
26301
US

IV. Provider business mailing address

ROUTE 98 MEDWOOD PLAZA SUITE 302
NUTTER FORT WV
26301
US

V. Phone/Fax

Practice location:
  • Phone: 304-622-5711
  • Fax: 304-622-6001
Mailing address:
  • Phone: 304-622-5711
  • Fax: 304-622-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3034
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019276
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: