Provider Demographics
NPI:1366561284
Name:DAVIS, DANIEL H
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 BROWN TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3942
Mailing Address - Country:US
Mailing Address - Phone:817-656-9366
Mailing Address - Fax:817-581-6874
Practice Address - Street 1:4000 BROWN TRL
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3942
Practice Address - Country:US
Practice Address - Phone:817-656-9366
Practice Address - Fax:817-581-6874
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist