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General NPI Number Information
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NPI Number | 1255072351
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Entity Type | Organization
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Legal Business Name | JERIT DAVIS DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 3393 G ST STE B
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City | MERCED
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State | CA
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Zip | 95340-1001
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Country | US
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Telephone | 209-385-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 6988 LEBANON RD STE 102
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City | FRISCO
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State | TX
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Zip | 75034-6743
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNING DDS
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Name | JERIT DAVIS
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Credential | DDS
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Telephone | 214-491-8398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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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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