MEDICARE: DR. JAMESON BERT DAVIS DDS

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	1603	WY

General Provider Information

NPI Number	:	1184293169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMESON BERT DAVIS DDS

Provider Business Mailing Address
First Line	:	1431 S BEVERLY ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-4131
Country	:	US
Telephone Number	:	307-265-5334
Fax Number	:

Provider Business Practice Location Address
First Line	:	1431 S BEVERLY ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-4131
Country	:	US
Telephone Number	:	307-265-5334
Fax Number	:

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

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	09/14/2023

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