Provider Demographics
NPI:1427163922
Name:DAVIS, CHERYL ELISE (DMD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ELISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200995
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-0995
Mailing Address - Country:US
Mailing Address - Phone:210-212-8707
Mailing Address - Fax:210-212-8780
Practice Address - Street 1:210 CHESTNUT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-2720
Practice Address - Country:US
Practice Address - Phone:210-212-8707
Practice Address - Fax:210-212-8780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist