=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265672042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR CARROLL DAVIS D.D.S., P.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2009
-----------------------------------------------------
Last Update Date | 11/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10230 NEW HAMPSHIRE AVENUE SUITE #330
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-928-8416
-----------------------------------------------------
Fax | 240-313-9661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10230 NEW HAMPSHIRE AVENUE SUITE #330
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-928-8416
-----------------------------------------------------
Fax | 240-313-9661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 4803
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------