MEDICARE: DR. LEONARD ERNEST DAVIS JR. 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	1223G0001X	General Practice Dentistry	2226	SC
2	122300000X	Dentist	2901008368	MI

General Provider Information

NPI Number	:	1891833034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD ERNEST DAVIS JR. DDS

Provider Business Mailing Address
First Line	:	PO BOX 30818
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29417-0818
Country	:	US
Telephone Number	:	843-763-8755
Fax Number	:

Provider Business Practice Location Address
First Line	:	8325 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2231
Country	:	US
Telephone Number	:	313-894-0000
Fax Number	:	313-894-0001

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	10/20/2011

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