Provider Demographics
NPI:1588407860
Name:MCCALLISTER, DAVIS MICHELLE (DDS)
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:MICHELLE
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DAVIS
Other - Middle Name:MICHELLE
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 DARTEN CIR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-2005
Mailing Address - Country:US
Mailing Address - Phone:573-356-3685
Mailing Address - Fax:
Practice Address - Street 1:3207 W ARAPAHO DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1363
Practice Address - Country:US
Practice Address - Phone:870-491-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240204311223G0001X
AR47551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice