Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 1145 | AK |
Y | 122300000X | Dentist | 7848 | NC |
N | 1223D0001X | Dental Public Health | 1145 | AK |
NPI | 1013003268 |
---|---|
Provider Name | Dr. Nolan Ellis Davis |
First Address | Juneau, AK 99801-8589 |
Second Address | Hudson, NC 28638-2449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 20/08/2009 |