MEDICARE: LAURA 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN011238	GA

General Provider Information

NPI Number	:	1972653871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA C DAVIS DDS

Provider Business Mailing Address
First Line	:	2033 MOUNT ZION RD
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-3313
Country	:	US
Telephone Number	:	770-471-5252
Fax Number	:	770-471-5283

Provider Business Practice Location Address
First Line	:	2033 MOUNT ZION RD
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-3313
Country	:	US
Telephone Number	:	770-471-5022
Fax Number	:	770-471-5283

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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