Larry Dennis Davis Sr.

Primary specialty

DentistTaxonomy code 122300000X

License

DN122431 Issued in GA

Practice address

1030 W Gordon Ave Ste a
Albany, GA 31701-4515

Phone

(229) 352-6610

NPI assigned

Jul 28, 2014

Last updated

Jan 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Innovation Dental Care LLC

  dba South Georgia Smiles

  • Dental Clinic/Center
  • Albany, GA
  • NPI 1942165360
  Authorized official Same address or phone

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": []
}

• Derek Joseph Davis, MS, LAT, ATC
• Derik Oliver Davis, MS, LAT, ATC
• Eleanor Sharon Davis, CNM
• Jefferson U Davis, DDS, MD.
• John B Davis Jr., MD
• Latasha Davis
• Michael Anthony Davis, M.D.
• Patricia Davis, LCSW
• Patricia A.S. Davis
• Quentin Tremain Davis

• Dentist in Albany, GA
• Providers in Albany, GA by specialty
• Dentist in Georgia

• 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.

Verify at the official NPI Registry.