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General NPI Number Information
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NPI Number | 1093234684
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Entity Type | Individual
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Provider Name | JOHN DAVIS
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Gender | Male
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7100 HIGHWAY 98 SUITE 210
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City | HATTIESBURG
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State | MS
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Zip | 39402-8601
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Country | US
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Telephone | 601-255-4546
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 HIGHWAY 98 SUITE 210
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City | HATTIESBURG
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State | MS
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Zip | 39402-8601
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Country | US
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Telephone | 601-255-4546
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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 | 1828-79
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License Number State | MS
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