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General NPI Number Information
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NPI Number | 1932244795
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Entity Type | Individual
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Provider Name | JOHN EDWARD DAVIS D.D.S,
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 501 66TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-6939
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Country | US
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Telephone | 727-343-1138
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Fax | 727-384-9095
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Provider Business Mailing Address
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Address Line | 501 66TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-6939
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Country | US
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Telephone | 727-343-1138
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Fax | 727-384-9095
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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 | DN4287
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License Number State | FL
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