Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 23779 | TX |
NPI | 1124282900 |
---|---|
Provider Name | Dr. Joshua Michael Davis |
First Address | Abilene, TX 79606-3375 |
Second Address | Abilene, TX 79606-3375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 02/03/2011 |