Provider Demographics
NPI:1215052378
Name:DAVIDSON, WANDA L (DDS)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 K ST NW
Mailing Address - Street 2:SUITE 15B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1103
Mailing Address - Country:US
Mailing Address - Phone:202-775-0022
Mailing Address - Fax:
Practice Address - Street 1:1990 K ST NW
Practice Address - Street 2:SUITE 15B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1103
Practice Address - Country:US
Practice Address - Phone:202-775-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10002121223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics