Provider Demographics
NPI:1447310990
Name:DAVIS, DELBERT ALEXANDER (DMD)
Entity type:Individual
Prefix:
First Name:DELBERT
Middle Name:ALEXANDER
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-2870
Mailing Address - Country:US
Mailing Address - Phone:419-729-3974
Mailing Address - Fax:419-729-9476
Practice Address - Street 1:4851 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-2870
Practice Address - Country:US
Practice Address - Phone:419-729-3974
Practice Address - Fax:419-729-9476
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-021619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist