Organization
MICHELLE DEARINGER-DAVIS DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE L DAVIS MD (OWNER/DENTIST)
(417) 494-5017
Entity
Organization
Contact information
Practice address
708 W MOUNT VERNON ST, NIXA, MO 65714-9682
(417) 494-5017
(417) 494-5019
Mailing address
708 W MT VERNON, NIXA, MO 65714-0000
(417) 494-5017
(417) 494-5019
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
016130
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016130
STATE LICENSE
MO
01
—
1100329
STATE DRUG LICENSE
MO
Enumeration date
12/09/2015
Last updated
03/07/2023
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