Individual
TIMOTHY L. DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1002 MERIDIAN AVE, COZAD, NE 69130-1757
(308) 784-3377
Mailing address
PO BOX 248, COZAD, NE 69130-0248
(308) 784-3377
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6613
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025385300
—
NE
Enumeration date
10/13/2006
Last updated
07/08/2007
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