Organization
RUSTIC MOUNTAIN DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH HOUSTON DAVIS DMD (DOCTOR/OWNER)
(928) 457-0758
Entity
Organization
Contact information
Practice address
606 N MAIN STREET, TAYLOR, AZ 85939-8593
(928) 457-0758
(928) 457-0821
Mailing address
PO BOX 1550, TAYLOR, AZ 85939-1550
(928) 457-0758
(928) 457-0821
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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