Individual
RYAN JACOB DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
NAVAL MEDICAL CENTER SAN DIEGO, 34800 BOB WILSON DRIVE, SAN DIEGO, CA 92134-5000
(619) 532-7935
Mailing address
2301 E ALLEGHENY AVE # 202, PHILADELPHIA, PA 19134-4427
(619) 532-7935
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS040786
PA
1223P0221X
Pediatric Dentistry
Primary
DS040786
PA
390200000X
Student in an Organized Health Care Education/Training Program
DS040786
PA
Other
Enumeration date
05/23/2016
Last updated
07/06/2022
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