Active NPI
John Philip McKenzie Davis, DDS
- Dentist
- Pine Bluff, AR
National Provider Identifier
1013490218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4306
- Practice address
- 4100 W 28TH Ave
Pine Bluff, AR 71603-4726 - Phone
- (870) 879-4870
- NPI assigned
- Sep 13, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4306 | AR | Primary |
Addresses
Primary practice location
4100 W 28TH Ave
Pine Bluff, AR 71603-4726
Mailing address
4100 W 28TH Ave
Pine Bluff, AR 71603-4726
Phone (870) 879-4870
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4306 | AR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536796800000",
"number": "1013490218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 W 28TH AVE",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716034726",
"telephone_number": "870-879-4870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 W 28TH AVE",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716034726",
"telephone_number": "870-879-4870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JOHN PHILIP",
"middle_name": "MCKENZIE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-13",
"last_updated": "2018-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "4306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine Bluff, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.