Provider Demographics
NPI:1962701946
Name:J. PATRICK DAVIS & MATTHEW DAVIS
Entity type:Organization
Organization Name:J. PATRICK DAVIS & MATTHEW DAVIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:J. PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:760-942-1131
Mailing Address - Street 1:477 N EL CAMINO REAL STE B203
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1353
Mailing Address - Country:US
Mailing Address - Phone:760-942-1131
Mailing Address - Fax:760-942-4868
Practice Address - Street 1:477 N EL CAMINO REAL STE B203
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1353
Practice Address - Country:US
Practice Address - Phone:760-942-1131
Practice Address - Fax:760-942-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26834261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental