Provider Demographics
NPI:1861953036
Name:FAMILI, DAVIS (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:
Last Name:FAMILI
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 1:11500 W OLYMPIC BLVD STE 508
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1528
Mailing Address - Country:US
Mailing Address - Phone:310-477-7744
Mailing Address - Fax:310-477-1144
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 508
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1528
Practice Address - Country:US
Practice Address - Phone:310-477-7744
Practice Address - Fax:310-477-1144
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist