Active NPI
Timothy Michael Davidson Jr., D.M.D.
- Dentist
- Winter Garden, FL
National Provider Identifier
1184076275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN22112
- Practice address
- 13361 W Colonial Dr
Winter Garden, FL 34787-3970 - Phone
- (407) 905-9622
- NPI assigned
- Jul 13, 2016
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN22112 | FL | Primary |
Addresses
Primary practice location
13361 W Colonial Dr
Winter Garden, FL 34787-3970
Mailing address
926 Great Pond Dr
1000
Altamonte Springs, FL 32714-7244
Phone (407) 862-0444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- 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 |
|---|---|---|---|---|
| I20160913002994 | FL | Order and Referring Only - Dentist | 7113213323 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470009600000",
"number": "1184076275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "926 GREAT POND DR",
"address_2": "1000",
"city": "ALTAMONTE SPRINGS",
"state": "FL",
"postal_code": "327147244",
"telephone_number": "407-862-0444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13361 W COLONIAL DR",
"city": "WINTER GARDEN",
"state": "FL",
"postal_code": "347873970",
"telephone_number": "407-905-9622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "TIMOTHY",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-13",
"last_updated": "2016-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN22112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Garden, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2016; 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.