Provider Demographics
NPI:1548553589
Name:AMY C. DAVIDIAN, DDS, PA
Entity type:Organization
Organization Name:AMY C. DAVIDIAN, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CUMMINGS
Authorized Official - Last Name:DAVIDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-624-8967
Mailing Address - Street 1:249 E NC HIGHWAY 54
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7512
Mailing Address - Country:US
Mailing Address - Phone:336-624-8967
Mailing Address - Fax:
Practice Address - Street 1:249 E NC HIGHWAY 54
Practice Address - Street 2:SUITE 300
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7512
Practice Address - Country:US
Practice Address - Phone:336-624-8967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty