Provider Demographics
NPI:1316960438
Name:DAVIS, GREGORY P (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
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 1:4834 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:30C
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6826
Mailing Address - Country:US
Mailing Address - Phone:513-459-1377
Mailing Address - Fax:513-229-7879
Practice Address - Street 1:4834 SOCIALVILLE FOSTER RD
Practice Address - Street 2:30C
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6826
Practice Address - Country:US
Practice Address - Phone:513-459-1377
Practice Address - Fax:513-229-7879
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300173241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice