Provider Demographics
NPI:1447257977
Name:DAVIS, PAUL G (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
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 1:2213 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3607
Mailing Address - Country:US
Mailing Address - Phone:817-354-9999
Mailing Address - Fax:817-354-1301
Practice Address - Street 1:2213 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3607
Practice Address - Country:US
Practice Address - Phone:817-354-9999
Practice Address - Fax:817-354-1301
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice