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Individual

BROCK DAVIDSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
509 MAIN ST, DIAMOND SPRINGS, CA 95619-9105
(530) 621-1051
Mailing address
509 MAIN ST, DIAMOND SPRINGS, CA 95619-9105
(530) 621-1051

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
103896
CA

Other

Enumeration date
07/18/2019
Last updated
07/18/2019
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