Active NPI
Brianna Estelle Davydov, DDS
- Dentist
- Brooklyn, NY
National Provider Identifier
1215437645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 060989
- Practice address
- 219 54TH St
Brooklyn, NY 11220-2610 - Phone
- (347) 377-5100
- NPI assigned
- Feb 12, 2018
- Sex
- Female
- 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 | 060989 | NY | Primary |
Addresses
Primary practice location
219 54TH St
Brooklyn, NY 11220-2610
Mailing address
1362 27TH Ave
San Francisco, CA 94122-1509
Other practice location 1
1362 27th Ave
San Francisco, CA 94122-1509
Phone (516) 376-2586
Other names 1
- Dr. Brianna Estelle Devito
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- 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 |
|---|---|---|---|---|
| I20240907000530 | NY | Order and Referring Only - Orthodontics and Dentofacial Orthopedics | 4082154893 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 060989 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723075200000",
"number": "1215437645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1362 27TH AVE",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941221509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 54TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112202610",
"telephone_number": "347-377-5100"
}
],
"practiceLocations": [
{
"address_1": "1362 27th Ave",
"address_purpose": "LOCATION",
"city": "San Francisco",
"state": "CA",
"postal_code": "941221509",
"country_code": "US",
"telephone_number": "516-376-2586",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVYDOV",
"first_name": "BRIANNA",
"middle_name": "ESTELLE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-02-12",
"last_updated": "2024-08-08",
"certification_date": "2024-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "060989",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BRIANNA",
"last_name": "DEVITO",
"middle_name": "ESTELLE",
"prefix": "DR.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.