Provider Demographics
NPI:1558360826
Name:DAVIS, STEPHEN EARL (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EARL
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 1:1320 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5616
Mailing Address - Country:US
Mailing Address - Phone:936-291-3345
Mailing Address - Fax:936-291-9866
Practice Address - Street 1:1320 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5616
Practice Address - Country:US
Practice Address - Phone:936-291-3345
Practice Address - Fax:936-291-9866
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-2113901OtherTAX ID
TX10039OtherSTATE LICENSE
TX74-2113901OtherTAX ID
TX00HC39Medicare ID - Type Unspecified