Provider Demographics
NPI:1235578741
Name:DAVIS, ADAM (DDS)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
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 1:716 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4506
Mailing Address - Country:US
Mailing Address - Phone:520-326-8516
Mailing Address - Fax:
Practice Address - Street 1:716 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4506
Practice Address - Country:US
Practice Address - Phone:520-326-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0091261223P0221X
VA0442000181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty