MEDICARE: DR. ROBERT A. DAVIS

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	9489	MI

General Provider Information

NPI Number	:	1982978086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ROBERT A. DAVIS

Provider Business Mailing Address
First Line	:	2710 WEST COURT STREET SUITE 6
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-3061
Country	:	US
Telephone Number	:	810-232-1911
Fax Number	:	810-232-1891

Provider Business Practice Location Address
First Line	:	2710 W COURT ST STE 6
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-3061
Country	:	US
Telephone Number	:	810-232-1911
Fax Number	:	810-232-1891

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ROBERT A DAVIS
Credential	:	DDS PC
Telephone Number	:	810-232-1911

Provider Enumeration Date	:	03/07/2012
Last Update Date	:	03/07/2012

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