Provider Demographics
NPI:1487715595
Name:DAVIS, GERESE (DDS)
Entity type:Individual
Prefix:DR
First Name:GERESE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19073 I-45 SOUTH
Mailing Address - Street 2:STE. 185
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77385
Mailing Address - Country:US
Mailing Address - Phone:936-273-0034
Mailing Address - Fax:936-273-0082
Practice Address - Street 1:19073 I-45 SOUTH
Practice Address - Street 2:STE. 185
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77385
Practice Address - Country:US
Practice Address - Phone:936-273-0034
Practice Address - Fax:936-273-0082
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist