Provider Demographics
NPI:1053733626
Name:DAVIS, JOSEPH HENRY JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HENRY
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:H
Other - Last Name:DAVIS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:STE #630
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-230-1161
Mailing Address - Fax:602-230-5443
Practice Address - Street 1:3003 N CENTRAL AVE
Practice Address - Street 2:STE #630
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2902
Practice Address - Country:US
Practice Address - Phone:602-230-1161
Practice Address - Fax:602-230-5443
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice