Basic Information
| Provider Information | |||||||||
| NPI: | 1881847739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8390 CHAMPIONS GATE BLVD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | CHAMPIONS GATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338968310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073901677 | ||||||||
| FaxNumber: | 4073901765 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 SE 3RD AVE | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333161178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547612230 | ||||||||
| FaxNumber: | 9547612231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2008 | ||||||||
| LastUpdateDate: | 07/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN12301 | FL | Y | Dental Providers | Dentist |
No ID Information.