Active NPI
Peter Thomas Davis, DDS FAGD
- Dentist
- Bethlehem, PA
National Provider Identifier
1205844156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS017836L
- Practice address
- 201 West Broad Street
Bethlehem, PA 18018-5517 - Phone
- (610) 865-3333
- Fax
- (610) 691-7822
- NPI assigned
- Aug 4, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | DS017836L | PA | Primary |
Addresses
Primary practice location
201 West Broad Street
Bethlehem, PA 18018-5517
Mailing address
201 West Broad Street
Bethlehem, PA 18018-5517
Phone (610) 865-3333
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130256 | Other | PA | BCID |
| AD5582778 | Other | PA | BNDD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 17, 2015 through Jun 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS017836L | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205844156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 WEST BROAD STREET",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180185517",
"telephone_number": "610-865-3333",
"fax_number": "610-691-7822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 WEST BROAD STREET",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180185517",
"telephone_number": "610-865-3333",
"fax_number": "610-691-7822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "PETER",
"middle_name": "THOMAS",
"credential": "DDS FAGD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS017836L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCID",
"identifier": "130256",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BNDD",
"identifier": "AD5582778",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethlehem, PA
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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.