MEDICARE: GREGG R DAVIDSON 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	30529	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30529	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1942389937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGG R DAVIDSON DDS

Provider Business Mailing Address
First Line	:	6600 MERCY CT STE 200
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-3198
Country	:	US
Telephone Number	:	916-966-6060
Fax Number	:	916-966-1330

Provider Business Practice Location Address
First Line	:	6600 MERCY CT STE 200
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-3198
Country	:	US
Telephone Number	:	916-966-6060
Fax Number	:	916-966-1330

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	09/23/2013

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Directions to “ GREGG R DAVIDSON DDS” Practice Location

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