Provider Demographics
NPI:1902939978
Name:DAVIS, KEISHA BROWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:BROWN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:500 HOLLY SPRINGS RD
Mailing Address - Street 2:SUITE 104 - DENTAL OFFICE
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-6204
Mailing Address - Country:US
Mailing Address - Phone:919-557-1871
Mailing Address - Fax:
Practice Address - Street 1:500 HOLLY SPRINGS RD
Practice Address - Street 2:SUITE 104 - DENTAL OFFICE
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-6204
Practice Address - Country:US
Practice Address - Phone:919-557-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899010UMedicaid