Individual
DR. GORDON BRUCE DAVIS
Active
Individual
DR. GORDON BRUCE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4915
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14666
MD LICENSE NUMBER
WA
01
—
21701
DENTAL LICENSE NUMBER
CA
01
—
5161
WASHINGTON DENTAL SERVICE
WA
01
—
DE00004915
DENTAL LICENSE NUMBER
WA
Enumeration date
10/10/2006
Last updated
05/05/2016
Update your record
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