MEDICARE: GEORGE A. DAVIS, JR. DDS LTD

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	3205	NV

General Provider Information

NPI Number	:	1972038123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE A. DAVIS, JR. DDS LTD

Provider Business Mailing Address
First Line	:	1930 VILLAGE CENTER CIR
Second Line	:	SUITE 12
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6299
Country	:	US
Telephone Number	:	702-562-2322
Fax Number	:	702-562-9610

Provider Business Practice Location Address
First Line	:	1930 VILLAGE CENTER CIR
Second Line	:	SUITE 12
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6299
Country	:	US
Telephone Number	:	702-562-2322
Fax Number	:	702-562-9610

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEORGE A DAVIS JR.
Credential	:	DDS
Telephone Number	:	702-562-2322

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	04/25/2017

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