MEDICARE: DR. DAVID C DAVIS 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	122300000X	Dentist	30013604	OH

General Provider Information

NPI Number	:	1881700979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID C DAVIS DDS

Provider Business Mailing Address
First Line	:	5900 SHARON WOODS BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2600
Country	:	US
Telephone Number	:	614-882-4434
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 SHARON WOODS BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2600
Country	:	US
Telephone Number	:	614-882-4434
Fax Number	:

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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