Individual
DR. JEREMY BLAZE DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
401 N GREAT NECK RD STE 122, VIRGINIA BEACH, VA 23454-4063
(757) 962-2499
Mailing address
857 BISHOPSGATE LN, VIRGINIA BEACH, VA 23452-6181
(210) 837-0716
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0401412449
VA
Other
Enumeration date
09/06/2005
Last updated
04/25/2019
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