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General NPI Number Information
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NPI Number | 1114149374
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Entity Type | Organization
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Legal Business Name | NATHANIEL DAVIS,DDS,PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 24060 WEST 10 MILE SUITE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48033
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Country | US
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Telephone | 248-350-9415
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Fax | 248-350-9412
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Provider Business Mailing Address
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Address Line | 24060 W 10 MILE RD SUITE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3006
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Country | US
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Telephone | 248-350-9415
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Fax | 248-350-9412
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NATHANIEL DAVIS
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Credential | DDS
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Telephone | 248-350-9415
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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 |
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License Number State |
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