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General NPI Number Information
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NPI Number | 1578322897
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Entity Type | Organization
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Legal Business Name | DAVIS FAMILY DENTAL, SC
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 1201 OAK ST STE D
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City | WEST BEND
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State | WI
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Zip | 53095-3800
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Country | US
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Telephone | 262-310-1860
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Fax | 262-310-1861
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Provider Business Mailing Address
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Address Line | N161W20685 KAMI LN
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City | JACKSON
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State | WI
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Zip | 53037-8937
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Country | US
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Telephone | 262-622-1571
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TYLER M DAVIS
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Credential | DDS
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Telephone | 262-310-1860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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