Provider Demographics
NPI:1730252982
Name:DAVIDSON, TROY D (DDS)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:D
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7209
Mailing Address - Country:US
Mailing Address - Phone:801-602-5541
Mailing Address - Fax:
Practice Address - Street 1:410 PEACHTREE PKWY
Practice Address - Street 2:BLDG400, SUITE 4250
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7066
Practice Address - Country:US
Practice Address - Phone:770-622-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237371223G0001X
WADE000107011223G0001X
IDD-4407-PD1223P0221X
TX273041223P0221X
UT6545604-9923122300000X
GADN0146291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist