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General NPI Number Information
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NPI Number | 1295174571
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Entity Type | Organization
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Legal Business Name | DAVIS DENTAL
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 1771 COMMONS NORTH LOOP
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City | TUSCALOOSA
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State | AL
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Zip | 35406-3577
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Country | US
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Telephone | 205-523-0446
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Fax | 205-523-0449
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Provider Business Mailing Address
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Address Line | 1771 COMMONS NORTH LOOP
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City | TUSCALOOSA
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State | AL
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Zip | 35406-3577
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Country | US
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Telephone | 205-523-0446
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Fax | 205-523-0449
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PATRICK LEE DAVIS
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Credential | DMD
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Telephone | 205-523-0446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6002C1
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5359
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License Number State | AL
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