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General NPI Number Information
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NPI Number | 1538283924
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Entity Type | Individual
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Provider Name | OLEN BEN DAVIS DDS
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 10320 MALLARD CREEK RD. SUITE 150
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City | CHARLOTTE
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State | NC
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Zip | 28262
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Country | US
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Telephone | 704-547-8438
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Fax | 704-547-9323
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Provider Business Mailing Address
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Address Line | PO BOX 36
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City | DAVIDSON
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State | NC
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Zip | 28036
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Country | US
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Telephone | 443-845-4647
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7835
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License Number State | NC
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