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General NPI Number Information
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NPI Number | 1063966703
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Entity Type | Organization
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Legal Business Name | DAVIS DENTAL HEALTH
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 14212 AMBAUM BLVD SW SUITE 100
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City | BURIEN
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State | WA
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Zip | 98166-1449
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Country | US
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Telephone | 206-762-8433
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Fax |
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Provider Business Mailing Address
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Address Line | 14212 AMBAUM BLVD SW SUITE 100
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City | BURIEN
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State | WA
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Zip | 98166-1449
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Country | US
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Telephone | 206-762-8433
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | ELIZABETH DAVIS
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Credential | DMD
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Telephone | 206-762-8433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60383802
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License Number State | WA
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