1144478652 NPI number — MARK E. DAVIS,D.D.S.,P.A.

Table of content: (NPI 1144478652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144478652 NPI number — MARK E. DAVIS,D.D.S.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK E. DAVIS,D.D.S.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRISCO ORAL & DENTAL IMPLANT SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144478652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3535 VICTORY GROUP WAY
Provider Second Line Business Mailing Address:
STE. 605
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-6719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-335-8717
Provider Business Mailing Address Fax Number:
972-731-0264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 VICTORY GROUP WAY
Provider Second Line Business Practice Location Address:
STE. 605
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-335-8717
Provider Business Practice Location Address Fax Number:
972-731-0264
Provider Enumeration Date:
09/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-335-8717

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  18-114 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)