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General NPI Number Information
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NPI Number | 1104544782
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Entity Type | Individual
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Provider Name | SUSAN AGNES DAVIDSON DDS
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Gender | Female
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 410 W BLOOMINGDALE AVE FL 33511
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City | BRANDON
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State | FL
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Zip | 33511-7402
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Country | US
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Telephone | 813-654-0037
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Fax |
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Provider Business Mailing Address
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Address Line | 11239 FISH EAGLE DR
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City | RIVERVIEW
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State | FL
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Zip | 33569-5742
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Country | US
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Telephone | 813-494-0091
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN27197
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License Number State | FL
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