=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164218061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH DAVIS DMD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2025
-----------------------------------------------------
Last Update Date | 04/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 383 HEMPSTEAD TPKE
-----------------------------------------------------
City | WEST HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11552-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-241-5514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 626 ADAMS AVE
-----------------------------------------------------
City | WEST HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11552-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-241-5514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSEPH DAVIS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 516-241-5514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------