MEDICARE: TERESA K DAVIS DDS PLLC

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	D-5510	OK

General Provider Information

NPI Number	:	1174797039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESA K DAVIS DDS PLLC

Provider Business Mailing Address
First Line	:	4401 W MEMORIAL RD
Second Line	:	SUITE 135
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1785
Country	:	US
Telephone Number	:	405-751-5515
Fax Number	:	405-751-6606

Provider Business Practice Location Address
First Line	:	4401 W MEMORIAL RD
Second Line	:	SUITE 135
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1785
Country	:	US
Telephone Number	:	405-751-5515
Fax Number	:	405-751-6606

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. TERESA K DAVIS
Credential	:	DDS
Telephone Number	:	405-751-5515

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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