# EMELINE T. DAVIS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Dental LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790766483
- **Authorized official:** MRS. EMELINE T. DAVIS D.D.S. (DENTIST)
- **Authorized official phone:** (812) 232-4664

## Contact information

- **Practice address:** 2955 PROFESSIONAL LN, TERRE HAUTE, IN 47802-3300
- **Practice address phone:** (812) 232-4664
- **Practice address fax:** (812) 234-5427
- **Mailing address:** 2955 PROFESSIONAL LN, TERRE HAUTE, IN 47802-3300
- **Mailing address phone:** (812) 232-4664
- **Mailing address fax:** (812) 234-5427

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12008723 | IN | Yes |
| 122300000X | Dentist | 12009834 | IN | — |
| 122300000X | Dentist | 12010103 | IN | — |

## Other

- **Enumeration date:** 11/09/2005
- **Last updated:** 04/26/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100251550A | — | IN |