Active NPI
Randall Davis, DDS
- General Practice Dentistry
- Pagosa Springs, CO
National Provider Identifier
1134311137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 660
- Practice address
- 101 Pagosa St
Pagosa Springs, CO 81147 - Phone
- (970) 264-9436
- NPI assigned
- Aug 14, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 660 | CO | Primary |
Addresses
Primary practice location
101 Pagosa St
Pagosa Springs, CO 81147
Mailing address
PO Box 2336
101 Pagosa St
Pagosa Springs, CO 81147-2336
Phone (970) 264-9436
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 |
|---|---|---|---|
| 660 | CO | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Juan Dental LLC | Past | Accepting new patients | |
| San Juan Dental Hygiene LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Pagosa Springs, CO
- NPI 1477717387
-
- Dental Clinic/Center
- Pagosa Springs, CO
- NPI 1538849955
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187049600000",
"number": "1134311137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2336",
"address_2": "101 PAGOSA ST",
"city": "PAGOSA SPRINGS",
"state": "CO",
"postal_code": "811472336",
"telephone_number": "970-264-9436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 PAGOSA ST",
"city": "PAGOSA SPRINGS",
"state": "CO",
"postal_code": "81147",
"telephone_number": "970-264-9436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "RANDALL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-14",
"last_updated": "2007-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "660",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pagosa Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.