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General NPI Number Information
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NPI Number | 1558886630
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Entity Type | Individual
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Provider Name | SAMANTHA DAVIS
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Gender | Female
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 3769 QUARTON RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-4058
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Country | US
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Telephone | 248-894-1966
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Fax | 303-264-3879
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Provider Business Mailing Address
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Address Line | 3769 QUARTON RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-4058
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Country | US
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Telephone | 248-894-1966
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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