Provider Demographics
NPI:1831364231
Name:DAVEY, MICHAEL THOMAS (DMD, PH D)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:DAVEY
Suffix:
Gender:M
Credentials:DMD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HEALEY AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2429
Mailing Address - Country:US
Mailing Address - Phone:518-561-1170
Mailing Address - Fax:
Practice Address - Street 1:8 HEALEY AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2429
Practice Address - Country:US
Practice Address - Phone:518-561-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0526181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice