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General NPI Number Information
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NPI Number | 1801332127
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Entity Type | Individual
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Provider Name | EDWARD MITCHELL DAVIS JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 300 CARLSBAD VILLAGE DR SUITE 203
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City | CARLSBAD
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State | CA
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Zip | 92008-2900
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Country | US
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Telephone | 760-487-0203
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Fax |
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Provider Business Mailing Address
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Address Line | 1865 KNIGHTS FERRY DR
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City | CHULA VISTA
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State | CA
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Zip | 91913-1655
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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 |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 101113
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License Number State | CA
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