MEDICARE: DR. MARYANN R DAVIS DMD

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	DS020711L	PA

General Provider Information

NPI Number	:	1689869711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYANN R DAVIS DMD

Provider Business Mailing Address
First Line	:	3808 BRIGHTON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-1676
Country	:	US
Telephone Number	:	412-766-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3808 BRIGHTON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-1676
Country	:	US
Telephone Number	:	412-766-3100
Fax Number	:

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

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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