Walter I Davison, DDS
Individual provider Active NPI General Practice Dentistry · Torrinton, CT
NPI 1194807610 · NPPES record last updated Feb 25, 2013
Key facts
- NPI
- 1194807610
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3987 (CT)
- Practice address
- 49 Commercial Blvd
Torrinton, CT 06790 - Phone
- (860) 482-6700
- Fax
- (860) 482-6702
- NPI assigned
- Oct 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150908002295 | CT | Order and Referring Only - Dentist |
4284634924 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003987 | CT | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3987 | CT | Yes |
Addresses
Primary practice location
49 Commercial Blvd
Torrinton, CT 06790
Mailing address
49 Commercial Blvd
Torrington, CT 06790
Phone (860) 482-6700
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.