=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023209426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON MICHAEL DAVIS DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2007
-----------------------------------------------------
Last Update Date | 11/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2074 S 6TH ST
-----------------------------------------------------
City | KLAMATH FALLS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97601-3372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-880-2090
-----------------------------------------------------
Fax | 541-880-2092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2074 S 6TH ST
-----------------------------------------------------
City | KLAMATH FALLS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97601-3372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-880-2090
-----------------------------------------------------
Fax | 541-880-2092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D8964
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------