Provider Demographics
NPI:1093108243
Name:DAVIS, JOSEPH (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 ADAMS AVE # A
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2933
Mailing Address - Country:US
Mailing Address - Phone:516-241-5514
Mailing Address - Fax:
Practice Address - Street 1:29 N AIRMONT RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4242
Practice Address - Country:US
Practice Address - Phone:845-369-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061881-011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty