Individual
DR. GORDON BRUCE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., D.D.S.
Contact information
Practice address
1111 PACIFIC AVE, STE 1, EVERETT, WA 98201-4200
(425) 348-1382
(425) 903-4402
Mailing address
9810 MARINE VIEW DR, MUKILTEO, WA 98275-4110
(425) 348-1382
(425) 903-4402
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
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