Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN 21976 | FL |
NPI | 1073066759 |
---|---|
Provider Name | Dr. Clayton Davis |
First Address | Miami, FL 33176 |
Second Address | Miami, FL 33176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 28/07/2016 |