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General NPI Number Information
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NPI Number | 1316185275
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Entity Type | Individual
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Provider Name | DENNIS B DAVIS D.M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 719 BAYSHORE DR
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City | NICEVILLE
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State | FL
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Zip | 32578-2527
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Country | US
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Telephone | 850-678-6485
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Fax | 850-678-5245
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Provider Business Mailing Address
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Address Line | 719 BAYSHORE DR
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City | NICEVILLE
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State | FL
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Zip | 32578-2527
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN15956
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License Number State | FL
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