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General NPI Number Information
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NPI Number | 1922457746
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Entity Type | Organization
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Legal Business Name | COSTES DAVIS, DDS DENTAL PRACTICE
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 3015 CALLOWAY DR UNIT 14
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2659
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Country | US
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Telephone | 661-587-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 CALLOWAY DR UNIT 14
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2659
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Country | US
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Telephone | 661-587-6453
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Fax |
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Authorized Official
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Title or Position | BILLING/INSURANCE MANAGER
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Name | KELCIE DEE THOMPSON
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Credential |
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Telephone | 928-925-6522
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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 | 6359
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License Number State | CA
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