Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 22DI02707300 | NJ |
NPI | 1093108243 |
---|---|
Provider Name | Joseph Davis |
First Address | Lawrence, NY 11559-2606 |
Second Address | Jackson, NJ 08527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2015 |
Last Update Date | 24/06/2019 |