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General NPI Number Information
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NPI Number | 1912929191
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Entity Type | Individual
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Provider Name | DUANE ALLEN DAVIS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1704 JEFFERSON AVE
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City | MOUNT VERNON
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State | IL
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Zip | 62864-4331
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Country | US
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Telephone | 618-244-2440
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Fax | 618-244-0607
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Provider Business Mailing Address
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Address Line | 12107 E IDLEWOOD DR
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City | MOUNT VERNON
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State | IL
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Zip | 62864-8415
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Country | US
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Telephone | 618-242-0915
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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 |
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License Number State | IL
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