Active NPI
Mark Howard Davis, DDS
- Dentist
- Los Angeles, CA
National Provider Identifier
1306839162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 44469
- Practice address
- 1414 S Grand Ave
Suite 485
Los Angeles, CA 90015-3076 - Phone
- (213) 744-1752
- Fax
- (213) 744-1753
- NPI assigned
- Aug 26, 2005
- 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 | 44469 | CA | Primary |
Addresses
Primary practice location
1414 S Grand Ave
Suite 485
Los Angeles, CA 90015-3076
Mailing address
8390 Champions Gate Blvd
Suite 215
Champions Gate, FL 33896-8310
Phone (407) 390-1677
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G91674-01 | Other | CA | DENTI-CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20160317000836 | CA | Order and Referring Only - Dentist | 0840596813 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44469 | CA | MD | Dentist |
Interoperability endpoints
- mark.davis.1@26356.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469059200000",
"number": "1306839162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8390 CHAMPIONS GATE BLVD",
"address_2": "SUITE 215",
"city": "CHAMPIONS GATE",
"state": "FL",
"postal_code": "338968310",
"telephone_number": "407-390-1677",
"fax_number": "407-390-1765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 S GRAND AVE",
"address_2": "SUITE 485",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900153076",
"telephone_number": "213-744-1752",
"fax_number": "213-744-1753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MARK",
"middle_name": "HOWARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-26",
"last_updated": "2016-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "44469",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTI-CAL",
"identifier": "G91674-01",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; 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.