=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063514982
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAM SPIKER DAVIS D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2006
-----------------------------------------------------
Last Update Date | 01/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7575 SAN FELIPE ST SUITE 135
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77063-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-781-2800
-----------------------------------------------------
Fax | 713-783-2910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1220 AUGUSTA DR SUITE 200
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-781-2800
-----------------------------------------------------
Fax | 713-781-5641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 10386
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------