Individual provider Active NPI

Tyler Matheson Davis, DDS

  • General Practice Dentistry
  • Wake Forest, NC
National Provider Identifier
1104053057
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8811 Issued in NC
Practice address
814 S Main St
Wake Forest, NC 27587-2808
Phone
(919) 556-3780
Fax
(919) 556-1708
NPI assigned
Jun 18, 2009
Last updated
Sep 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 8811 NC
General Practice Dentistry 1223G0001X 8811 NC Primary

Addresses

Primary practice location

814 S Main St
Wake Forest, NC 27587-2808

Mailing address

814 S Main St
Wake Forest, NC 27587-2808
Phone (919) 556-3780

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

LicenseStateTypeSpecialty
8811NCMDDurable Medical Equipment & Medical Supplies

Practice roles

OrganizationSpecialtyStatusNew patients
Davis and Perry, DDS, PLLC General Practice Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1104053057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 S MAIN ST",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275872808",
            "telephone_number": "919-556-3780",
            "fax_number": "919-556-1708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 S MAIN ST",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275872808",
            "telephone_number": "919-556-3780",
            "fax_number": "919-556-1708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "TYLER",
        "middle_name": "MATHESON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-18",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NC",
            "license": "8811",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "8811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.