Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 16823 | TX |
NPI | 1083738025 |
---|---|
Provider Name | Dr. Joanna L. Davis |
First Address | Round Rock, TX 78681-4008 |
Second Address | Round Rock, TX 78681-4008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |