Provider Demographics
NPI:1699795666
Name:DAVIS, KENT ESTON (D M D)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:ESTON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 CLAYTON RD
Mailing Address - Street 2:SUITE A 19
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3139
Mailing Address - Country:US
Mailing Address - Phone:925-825-1130
Mailing Address - Fax:925-682-9115
Practice Address - Street 1:5100 CLAYTON RD
Practice Address - Street 2:SUITE A 19
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3139
Practice Address - Country:US
Practice Address - Phone:925-825-1130
Practice Address - Fax:925-682-9115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24444122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice