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General NPI Number Information
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NPI Number | 1477641041
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Entity Type | Individual
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Provider Name | GORDON BRUCE DAVIS M.D., D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 1111 PACIFIC AVE STE 1
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City | EVERETT
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State | WA
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Zip | 98201-4200
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Country | US
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Telephone | 425-348-1382
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Fax | 425-903-4402
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Provider Business Mailing Address
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Address Line | 9810 MARINE VIEW DR
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City | MUKILTEO
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State | WA
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Zip | 98275-4110
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Country | US
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Telephone | 425-348-1382
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Fax | 425-903-4402
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4915
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License Number State | WA
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