Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 6963 | CO |
NPI | 1013001171 |
---|---|
Provider Name | Dr. Matthew S Davis |
First Address | Thornton, CO 80241-3165 |
Second Address | Thornton, CO 80241-3165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |