Provider Demographics
NPI:1992974984
Name:DAVIS, BRIAN T (DDS)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:T
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 1:2417 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066
Mailing Address - Country:US
Mailing Address - Phone:770-926-6886
Mailing Address - Fax:770-926-2228
Practice Address - Street 1:2417 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066
Practice Address - Country:US
Practice Address - Phone:770-926-6886
Practice Address - Fax:770-926-2228
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA94141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice