Provider Demographics
NPI:1104168244
Name:DAVIS, DAVID W (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 ROME BEAUTY CIR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-4859
Mailing Address - Country:US
Mailing Address - Phone:478-960-9392
Mailing Address - Fax:256-547-5735
Practice Address - Street 1:901 LEIGHTON AVE STE 401
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5703
Practice Address - Country:US
Practice Address - Phone:256-236-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36271204E00000X
ALD6030.C11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery