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General NPI Number Information
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NPI Number | 1336641000
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Entity Type | Individual
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Provider Name | ZACHERY TYLER DAVIS
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Gender | Male
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 7525 N CEDAR AVE STE 105
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City | FRESNO
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State | CA
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Zip | 93720-2698
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Country | US
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Telephone | 559-439-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 1917 MINARETS LN
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City | CLOVIS
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State | CA
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Zip | 93611-6995
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Country | US
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Telephone | 801-946-2028
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DDS105061
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License Number State | CA
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