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General NPI Number Information
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NPI Number | 1689554164
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Entity Type | Organization
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Legal Business Name | DAVIDSON DENTAL INTERESTS LLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 716 S OAKWOOD AVE
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City | BRANDON
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State | FL
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Zip | 33511-6124
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Country | US
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Telephone | 813-494-0091
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Fax |
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Provider Business Mailing Address
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Address Line | 11239 FISH EAGLE DR
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City | RIVERVIEW
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State | FL
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Zip | 33569-5742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SUSAN AGNES DAVIDSON
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Credential | DDS
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Telephone | 813-494-0091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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