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General NPI Number Information
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NPI Number | 1659426815
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Entity Type | Organization
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Legal Business Name | DAVIS FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13925 W MEEKER BLVD SUITE TWO
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-4430
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Country | US
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Telephone | 623-537-5327
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5337
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City | SUN CITY WEST
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State | AZ
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Zip | 85376-5337
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Country | US
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Telephone | 623-537-5327
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | GREGORY DM DAVIS
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Credential |
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Telephone | 623-537-5327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D4553
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License Number State | AZ
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