MEDICARE: DR.V.DAVIS,PA

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	08631	MD

General Provider Information

NPI Number	:	1770645889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR.V.DAVIS,PA

Provider Business Mailing Address
First Line	:	PO BOX 439
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-0439
Country	:	US
Telephone Number	:	410-515-7525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2921 EMMORTON RD
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1631
Country	:	US
Telephone Number	:	410-515-7525
Fax Number	:

Authorized Official
Title or Position	:	CORPORATE OFFICER
Name	:	DR. VIDA DAVIS
Credential	:	DDS
Telephone Number	:	410-515-7525

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/24/2012

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