| Organization Name: | TOM DAVIES, D.D.S., LLC |
| NPI Number: | 1205106945 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS DAVIES (MANAGER) |
| Mailing Address: | 103 Superior St Sandpoint |
| State: | ID US |
| Postal Code: | 838641394 |
| Phone Number: | 7605195712 |
| Fax Number: | 8882226516 |
| NPI Enumeration Date: | 01/11/2012 |
| NPI Last Update Date: | 01/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D-4403 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |