Provider Demographics
NPI:1144654575
Name:DAVIES, D. ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:D. ALAN
Middle Name:
Last Name:DAVIES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 NORTHFIELD RD STE 310
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8600
Mailing Address - Country:US
Mailing Address - Phone:435-586-9055
Mailing Address - Fax:435-586-9104
Practice Address - Street 1:1251 NORTHFIELD RD STE 310
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8600
Practice Address - Country:US
Practice Address - Phone:435-586-9055
Practice Address - Fax:435-586-9104
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5114299-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$001Medicaid