MEDICARE: DR. ALLEN GLEN DAVIS D.D.S., 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	29576	CA

General Provider Information

NPI Number	:	1902951056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN GLEN DAVIS D.D.S., M.S.

Provider Business Mailing Address
First Line	:	9420 MIRA MESA BLVD STE J
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4848
Country	:	US
Telephone Number	:	858-578-5002
Fax Number	:	858-578-5832

Provider Business Practice Location Address
First Line	:	9420 MIRA MESA BLVD STE J
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4848
Country	:	US
Telephone Number	:	858-578-5002
Fax Number	:	858-578-5832

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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