Richard C Davis Jr., DDS – General Practice Dentistry

Key facts

NPI: 1073553038
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 40425 (CA)
Practice address: 24511 West Jayne Ave
Coalinga, CA 93210-5000
Phone: (559) 935-4301
Fax: (559) 935-7118
NPI assigned: Jun 7, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

State of California - Department of Developmental Services Federally Qualified Health Center (FQHC) · Pomona, CA · NPI 1093085565

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
40425	CA	MD	Licensed Psychiatric Technician

Practice roles

Organization	Specialty	Status	New patients
State of California - Department of Developmental Services		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	40425	CA	Yes

Addresses

Primary practice location

24511 West Jayne Ave
Coalinga, CA 93210-5000

Mailing address

1600 9TH St
Room 205 Mailstop 2-3
Sacramento, CA 95814-6414
Phone (916) 654-2431

Other providers in Coalinga, CA

All providers in Coalinga, CA · General Practice Dentistry in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.