Organization Name: | MARK DAVIS, DDS PC |
NPI Number: | 1013399641 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK C DAVIS (OWNER) |
Mailing Address: | 2301 Mountain View Blvd Ste D Klamath Falls |
State: | OR US |
Postal Code: | 976011137 |
Phone Number: | 5418829039 |
Fax Number: | 8664372057 |
NPI Enumeration Date: | 06/19/2015 |
NPI Last Update Date: | 06/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D8238 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |