Davis and Robertson DMD. PSC

Primary specialty

DentistTaxonomy code 122300000X

License

6708 Issued in KY

Legal business name

DAVIS AND ROBERTSON DMD. PSC

Doing business as

Destiny Dental

Practice address

1720 Destiny LN
Bowling Green, KY 42104-1063

Phone

(270) 842-3554

Fax

(270) 781-4644

NPI assigned

Jun 13, 2007

Last updated

Feb 2, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gina Renee Davis, DDSNPI 1750413936

Title

Dentist

Phone

(270) 842-3554

Specialties & licenses 1

Addresses

Other names 1

• Destiny Dental Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gina Renee Davis, D.M.D

  • General Practice Dentistry
  • Bowling Green, KY
  • NPI 1750413936
  NPD (past) Authorized official
• Stephen Wayne Robertson, D.M.D.,

  • General Practice Dentistry
  • Bowling Green, KY
  • NPI 1700890480
  NPD (past)

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454371200000",
    "number": "1134323165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 DESTINY LN",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421041063",
            "telephone_number": "270-842-3554",
            "fax_number": "270-781-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 DESTINY LN",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421041063",
            "telephone_number": "270-842-3554",
            "fax_number": "270-781-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS AND ROBERTSON DMD. PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2016-02-02",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "270-842-3554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "6708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Destiny Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily G. Davenport, PT
• David a. Buchanan, D.M.D.
• David Glenn Smith MD LLC
• Rebecca Rene David, MS, ATC, LAT
• Randall P. Davidson, MD
• Jayme Lauren Davis-Waddell, NP-C
• Amber Crigger Davis, MA, LPCC, LPC-MHSP,
• Ann-Ashleigh Davis, PT, DPT
• Ashley Marie Davis
• Benjamin Ryan Davis, CRNA, RN

• Dentist in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; 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.