Miranda Elizabeth Davis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11168 Issued in OR

Practice address

2084 NE Professional CT
Bend, OR 97701-6077

Phone

(541) 383-3005

Fax

(541) 383-1883

NPI assigned

Nov 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: mdavis720901@direct.ochin.org

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1164596201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4228",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084228",
            "telephone_number": "541-383-3005",
            "fax_number": "541-383-1883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2084 NE PROFESSIONAL CT",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016077",
            "telephone_number": "541-383-3005",
            "fax_number": "541-383-1883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2209 E 32nd St",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984044922",
            "country_code": "US",
            "telephone_number": "253-593-0232 x403",
            "fax_number": "253-593-0232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MIRANDA",
        "middle_name": "ELIZABETH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11168",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010692",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey J Davis, MD
• Jennifer Davis
• Jessica Davis
• John Arnold Davis, M.D.
• Kelsey Elizabeth Davis
• Mitchell Davis, PA
• Rachel Davis
• Savannah Marie Davis
• Tasmine Davis
• Alexandra Davoulas

• All providers in Bend, OR
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.