MEDICARE: DR. ANGELA DAVIDSON 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	21455	TX

General Provider Information

NPI Number	:	1265644074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA DAVIDSON DDS

Provider Business Mailing Address
First Line	:	417 CHAPARRAL DR
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-8090
Country	:	US
Telephone Number	:	512-965-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	8430 SPICEWOOD SPRINGS RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-6051
Country	:	US
Telephone Number	:	512-506-9430
Fax Number	:

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	01/13/2012

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