Individual
DANIELLA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 PORTION RD STE 15, LAKE RONKONKOMA, NY 11779-4587
(631) 588-1199
Mailing address
500 PORTION RD STE 15, LAKE RONKONKOMA, NY 11779-4587
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
061059
NY
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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