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General NPI Number Information
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NPI Number | 1891833034
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Entity Type | Individual
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Provider Name | LEONARD ERNEST DAVIS JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 8325 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48204-2231
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Country | US
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Telephone | 313-894-0000
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Fax | 313-894-0001
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Provider Business Mailing Address
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Address Line | PO BOX 30818
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City | CHARLESTON
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State | SC
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Zip | 29417-0818
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Country | US
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Telephone | 843-763-8755
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2226
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901008368
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License Number State | MI
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