Provider Demographics
NPI:1386612323
Name:DAVIS, EDWIN M
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-1577
Mailing Address - Country:US
Mailing Address - Phone:412-384-4444
Mailing Address - Fax:412-384-4445
Practice Address - Street 1:118 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-1577
Practice Address - Country:US
Practice Address - Phone:412-384-4444
Practice Address - Fax:412-384-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022500L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist