Organization
DAVIS PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A DAVIS DDS (DENTIST)
(307) 472-0207
Entity
Organization
Contact information
Practice address
5850 E 2ND ST, STE 100, CASPER, WY 82609-4342
(307) 472-0207
(307) 472-0259
Mailing address
5850 E 2ND ST, STE 100, CASPER, WY 82609-4342
(307) 472-0207
(307) 472-0259
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
1274
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568682011
INDIVIDUAL
WY
Enumeration date
04/03/2012
Last updated
04/03/2012
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