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General NPI Number Information
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NPI Number | 1205106945
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Entity Type | Organization
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Legal Business Name | TOM DAVIES, D.D.S., LLC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 103 SUPERIOR ST
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City | SANDPOINT
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State | ID
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Zip | 83864-1394
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Country | US
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Telephone | 760-519-5712
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Fax | 888-222-6516
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Provider Business Mailing Address
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Address Line | 3688 WRENCOE LOOP RD
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City | SANDPOINT
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State | ID
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Zip | 83864-6383
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Country | US
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Telephone | 760-519-5712
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Fax | 888-222-6516
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Authorized Official
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Title or Position | MANAGER
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Name | DR. THOMAS DAVIES
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Credential | D.D.S.
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Telephone | 760-519-5712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D-4403
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License Number State | ID
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