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General NPI Number Information
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NPI Number | 1841076288
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Entity Type | Organization
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Legal Business Name | SAMUEL C DAVIDSON DDS LLC
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Dates
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Enumeration Date | 09/01/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 337 GREYBULL AVE
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City | GREYBULL
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State | WY
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Zip | 82426-2049
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Country | US
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Telephone | 307-765-4654
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Fax | 307-333-0494
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Provider Business Mailing Address
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Address Line | 337 GREYBULL AVE
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City | GREYBULL
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State | WY
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Zip | 82426-2049
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Country | US
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Telephone | 307-765-4654
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Fax | 307-333-0494
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. AILINA S DAVIDSON
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Credential |
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Telephone | 307-272-1688
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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 |
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License Number State |
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