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General NPI Number Information
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NPI Number | 1366797664
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Entity Type | Organization
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Legal Business Name | DAVIS DERMATOLOGY, PA
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 6500 GREENVILLE AVE SUITE 195
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City | DALLAS
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State | TX
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Zip | 75206-1014
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Country | US
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Telephone | 214-363-3376
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Fax |
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Provider Business Mailing Address
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Address Line | 3330 HANOVER ST
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City | DALLAS
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State | TX
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Zip | 75225-7641
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Country | US
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Telephone | 214-363-3376
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LANCE DAVIS
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Credential | MD
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Telephone | 214-363-3376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | N6251
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License Number State | TX
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