Provider Demographics
NPI:1346320959
Name:REBECCA DAVIS, D.D.S., P.C.
Entity type:Organization
Organization Name:REBECCA DAVIS, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-225-1356
Mailing Address - Street 1:1330 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-4642
Mailing Address - Country:US
Mailing Address - Phone:918-225-1356
Mailing Address - Fax:918-225-3207
Practice Address - Street 1:1330 E 9TH ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4642
Practice Address - Country:US
Practice Address - Phone:918-225-1356
Practice Address - Fax:918-225-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty