=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144891854
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TALON A DAVIS DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2021
-----------------------------------------------------
Last Update Date | 07/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1450 DEBBIE LN STE 130
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76002-5073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-465-3454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2907 NEWSOM RIDGE DR
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-3194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-650-9901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | TALON A DAVIS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 405-650-9901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------