MEDICARE: DR. LEON D. DAVIS JR. D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33450	CA

General Provider Information

NPI Number	:	1083718431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON D. DAVIS JR. D.D.S

Provider Business Mailing Address
First Line	:	10430 SOUTH DE ANZA BOULIVARD
Second Line	:	SUITE 260
City	:	CUPERTINO
State	:	CA
Zip	:	95014
Country	:	US
Telephone Number	:	408-996-1007
Fax Number	:	408-996-3009

Provider Business Practice Location Address
First Line	:	10430 S DE ANZA BLVD
Second Line	:	SUITE 260
City	:	CUPERTINO
State	:	CA
Zip	:	95014-3019
Country	:	US
Telephone Number	:	408-996-1007
Fax Number	:	408-996-3009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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