Active NPI
Larry Dennis Davis Sr.
- Dentist
- Albany, GA
National Provider Identifier
1265840896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN122431
- Practice address
- 1030 W Gordon Ave Ste a
Albany, GA 31701-4515 - Phone
- (229) 352-6610
- NPI assigned
- Jul 28, 2014
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8673 | SC | |
| General Practice Dentistry | 1223G0001X | 3979-18 | MS | |
| Dentist | 122300000X | DN122431 | GA | Primary |
| Dentist | 122300000X | 04552 | TN |
Addresses
Primary practice location
1030 W Gordon Ave Ste a
Albany, GA 31701-4515
Mailing address
1613 Glenridge Dr
Nashville, TN 37221-5303
Phone (615) 364-4273
Other practice location 1
1499 R W Moore Memorial Hwy
Only, TN 37140-4050
Phone (931) 729-5161 ext. 2351
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN122431 | GA | MD | Dentist |
| 04552 | TN | MD | Dentist |
| 3979-18 | MS | MD | General Practice Dentistry |
| 8673 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705449600000",
"number": "1265840896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1613 GLENRIDGE DR",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372215303",
"telephone_number": "615-364-4273",
"fax_number": "615-292-9056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 W GORDON AVE STE A",
"city": "ALBANY",
"state": "GA",
"postal_code": "317014515",
"telephone_number": "229-352-6610"
}
],
"practiceLocations": [
{
"address_1": "1499 R W Moore Memorial Hwy",
"address_purpose": "LOCATION",
"city": "Only",
"state": "TN",
"postal_code": "371404050",
"country_code": "US",
"telephone_number": "931-729-5161 x2351",
"fax_number": "931-729-1151",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVIS",
"first_name": "LARRY",
"middle_name": "DENNIS",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-28",
"last_updated": "2024-01-17",
"certification_date": "2024-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "8673",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MS",
"license": "3979-18",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN122431",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "04552",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albany, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.