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General NPI Number Information
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NPI Number | 1962701946
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Entity Type | Organization
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Legal Business Name | J. PATRICK DAVIS & MATTHEW DAVIS
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 477 N EL CAMINO REAL STE B203
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City | ENCINITAS
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State | CA
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Zip | 92024-1353
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Country | US
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Telephone | 760-942-1131
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Fax | 760-942-4868
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Provider Business Mailing Address
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Address Line | 477 N EL CAMINO REAL STE B203
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City | ENCINITAS
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State | CA
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Zip | 92024-1353
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Country | US
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Telephone | 760-942-1131
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Fax | 760-942-4868
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MR. J. PATRICK DAVIS
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Credential | DDS, MS
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Telephone | 760-942-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 26834
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License Number State | CA
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