Active NPI
Richard Davidson, D.M.D.,M.S.
- Periodontics
- Clayton, MO
National Provider Identifier
1174732416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 11304
- Practice address
- 950 Francis PL
Suite 117
Clayton, MO 63105-2465 - Phone
- (314) 721-4860
- Fax
- (314) 721-4860
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 11304 | MO | Primary |
Addresses
Primary practice location
950 Francis PL
Suite 117
Clayton, MO 63105-2465
Mailing address
35 Summerhill LN
Chesterfield, MO 63017-8408
Phone (314) 434-1107
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160817001044 | MO | Order and Referring Only - Dentist | 5890080733 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11304 | MO | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174732416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 SUMMERHILL LN",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630178408",
"telephone_number": "314-434-1107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 FRANCIS PL",
"address_2": "SUITE 117",
"city": "CLAYTON",
"state": "MO",
"postal_code": "631052465",
"telephone_number": "314-721-4860",
"fax_number": "314-721-4860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "D.M.D.,M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MO",
"license": "11304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clayton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.