Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6987 | OK |
N | 126800000X | Dental Assistant |
NPI | 1356639876 |
---|---|
Provider Name | Dr. Davis Do |
First Address | Bixby, OK 74008-2534 |
Second Address | Tulsa, OK 74133-6103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2011 |
Last Update Date | 28/06/2019 |