Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | OH15900 | OH |
NPI | 1053388546 |
---|---|
Provider Name | Dr. William J Davis JR. |
First Address | Perrysburg, OH 43551 |
Second Address | Toledo, OH 43614-2595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 04/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0368669 | (05) | OH |
T47159 | (02) |