Provider Demographics
NPI:1720151277
Name:DAVIS, GARY S (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:S
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 1:420 E ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257
Mailing Address - Country:US
Mailing Address - Phone:717-532-4513
Mailing Address - Fax:717-532-7679
Practice Address - Street 1:420 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257
Practice Address - Country:US
Practice Address - Phone:717-532-4513
Practice Address - Fax:717-532-7679
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027270L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice