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General NPI Number Information
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NPI Number | 1710120621
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Entity Type | Individual
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Provider Name | RYAN MATTHEW DAVIS D.D.S
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Gender | Male
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 2D DENBN/NDC 2DMLG PCS BOX 20130
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City | CAMP LEJEUNE
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State | NC
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Zip | 28542-0130
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Country | US
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Telephone | 910-451-2208
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Fax | 910-451-8036
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Provider Business Mailing Address
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Address Line | PCS BOX 20130 2D DENBN/NDC 2DMLG
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City | CAMP LEJEUNE
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State | NC
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Zip | 28542-0130
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Country | US
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Telephone | 910-451-2208
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Fax | 910-451-8036
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30-022957
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License Number State | OH
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