Provider Demographics
NPI:1194932947
Name:DAVIS, LARRY A (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S O CONNOR RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-2950
Mailing Address - Country:US
Mailing Address - Phone:972-251-1701
Mailing Address - Fax:972-254-1189
Practice Address - Street 1:209 S O CONNOR RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-2950
Practice Address - Country:US
Practice Address - Phone:972-251-1701
Practice Address - Fax:972-254-1189
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice