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General NPI Number Information
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NPI Number | 1871816389
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Entity Type | Individual
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Provider Name | JAMES WILLIAM DAVIS D.M.D
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Gender | Male
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 2025 W ILES AVE SUITE F
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4190
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Country | US
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Telephone | 217-787-6761
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Fax | 217-787-6611
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Provider Business Mailing Address
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Address Line | 2025 W ILES AVE SUITE F
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4190
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Country | US
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Telephone | 217-787-6761
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Fax | 217-787-6611
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 021.001294
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License Number State | IL
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