Active NPI
Jason O. Davis, DDS
- Pediatric Dentistry
- Brooklyn, NY
National Provider Identifier
1306133392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 11888
- Practice address
- 4552 Kings Hwy
Brooklyn, NY 11234-2028 - Phone
- (718) 791-6295
- Fax
- (718) 791-6295
- NPI assigned
- Jun 29, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 057168 | NY | |
| Pediatric Dentistry | 1223P0221X | 11888 | CT | Primary |
Addresses
Primary practice location
4552 Kings Hwy
Brooklyn, NY 11234-2028
Mailing address
4552 Kings Hwy
Brooklyn, NY 11234-2028
Phone (917) 703-5962
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 |
|---|---|---|---|
| 11888 | CT | MD | Clinical Social Worker |
| 057168 | NY | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597017600000",
"number": "1306133392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4552 KINGS HWY",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112342028",
"telephone_number": "917-703-5962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4552 KINGS HWY",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112342028",
"telephone_number": "718-791-6295",
"fax_number": "718-791-6295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JASON",
"middle_name": "O.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-29",
"last_updated": "2020-08-10",
"certification_date": "2020-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "057168",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CT",
"license": "11888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.