Provider Demographics
NPI:1538379862
Name:DAVIS, DARLENE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0997
Mailing Address - Country:US
Mailing Address - Phone:770-906-4601
Mailing Address - Fax:770-831-7641
Practice Address - Street 1:1120 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2013
Practice Address - Country:US
Practice Address - Phone:770-831-7644
Practice Address - Fax:770-831-7641
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN117501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics