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General NPI Number Information
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NPI Number | 1700148004
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Entity Type | Organization
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Legal Business Name | CHARLES A DAVIS DDS MS PC
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 716 N COUNTRY CLUB RD
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City | TUCSON
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State | AZ
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Zip | 85716-4506
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Country | US
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Telephone | 520-326-8516
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Fax | 520-326-1013
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Provider Business Mailing Address
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Address Line | 716 N COUNTRY CLUB RD
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City | TUCSON
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State | AZ
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Zip | 85716-4506
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Country | US
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Telephone | 520-326-8516
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Fax | 520-326-1013
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. CHARLES A DAVIS
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Credential | DDS, MS
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Telephone | 520-326-8516
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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 | 1881
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License Number State | AZ
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