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General NPI Number Information
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NPI Number | 1003984360
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Entity Type | Individual
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Provider Name | ANGELA MARIE DAVIS DDS
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Gender | Female
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 306 N 6TH ST
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-3221
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Country | US
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Telephone | 870-732-2107
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Fax | 870-732-8843
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Provider Business Mailing Address
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Address Line | 35 DANNER CT APT 102
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City | MEMPHIS
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State | TN
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Zip | 38103-5990
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Country | US
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Telephone | 901-529-1061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3553
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8442
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License Number State | TN
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