Individual
RANDALL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
101 PAGOSA ST, PAGOSA SPRINGS, CO 81147
(970) 264-9436
Mailing address
PO BOX 2336, 101 PAGOSA ST, PAGOSA SPRINGS, CO 81147-2336
(970) 264-9436
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
660
CO
Other
Enumeration date
08/14/2007
Last updated
08/14/2007
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