MEDICARE: DR. T. BOB DAVIS D.M.D

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	122300000X	Dentist	8761	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	475454	OTHER	TX	UNITED CONCORDIA
2	B08760-01	OTHER	TX	DELTA DENTAL (CHIPS)

General Provider Information

NPI Number	:	1194838565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. T. BOB DAVIS D.M.D

Provider Business Mailing Address
First Line	:	8499 GREENVILLE AVE STE 210
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2412
Country	:	US
Telephone Number	:	214-553-8499
Fax Number	:	214-553-0142

Provider Business Practice Location Address
First Line	:	8499 GREENVILLE AVE STE 210
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2412
Country	:	US
Telephone Number	:	214-553-8499
Fax Number	:	214-553-0142

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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