Provider Demographics
NPI:1982978086
Name:DR. ROBERT A. DAVIS
Entity type:Organization
Organization Name:DR. ROBERT A. DAVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:810-232-1911
Mailing Address - Street 1:2710 WEST COURT STREET SUITE 6
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-3061
Mailing Address - Country:US
Mailing Address - Phone:810-232-1911
Mailing Address - Fax:810-232-1891
Practice Address - Street 1:2710 W COURT ST STE 6
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3061
Practice Address - Country:US
Practice Address - Phone:810-232-1911
Practice Address - Fax:810-232-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI94891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty