MEDICARE: GREGORY DAVIS DDS INC.

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	21869	CA

General Provider Information

NPI Number	:	1457535700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY DAVIS DDS INC.

Provider Business Mailing Address
First Line	:	4626 MERCURY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2410
Country	:	US
Telephone Number	:	858-292-8180
Fax Number	:	858-292-0690

Provider Business Practice Location Address
First Line	:	4626 MERCURY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2410
Country	:	US
Telephone Number	:	858-292-8180
Fax Number	:	858-292-0690

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY PARKE DAVIS
Credential	:	DDS
Telephone Number	:	858-292-8180

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	12/21/2007

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