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General NPI Number Information
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NPI Number | 1457353278
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Entity Type | Organization
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Legal Business Name | MARK M. DAVIS, D.D.S., PC
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5301 S LEWIS AVE
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City | TULSA
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State | OK
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Zip | 74105-6539
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Country | US
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Telephone | 918-742-8100
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Fax | 918-858-1049
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Provider Business Mailing Address
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Address Line | 5301 S LEWIS AVE
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City | TULSA
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State | OK
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Zip | 74105-6539
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Country | US
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Telephone |
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Fax | 918-858-1049
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Authorized Official
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Title or Position | OWNER
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Name | MARK M DAVIS
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Credential | D.D.S.
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Telephone | 918-742-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | OK
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