MEDICARE: DR. JAY DAVIS D.M.D., M.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	26510	TX
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	60394	CA
3	122300000X	Dentist	5697	NV
4	122300000X	Dentist	6975643-9921	UT

General Provider Information

NPI Number	:	1699930321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY DAVIS D.M.D., M.S.

Provider Business Mailing Address
First Line	:	1750 WHEELER PEAK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2150
Country	:	US
Telephone Number	:	702-272-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 WHEELER PEAK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2150
Country	:	US
Telephone Number	:	702-272-1100
Fax Number	:

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

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	12/07/2016

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