Nodari Davitiashvili, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

010921 Issued in CT

Practice address

3902 Sedgwick Ave
Bronx, NY 10463-4460

Phone

(917) 495-1000

Fax

(917) 495-1000

NPI assigned

Jun 11, 2007

Last updated

Jun 10, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Nodari Daviti Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370822400000",
    "number": "1417151945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3902 SEDGWICK AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104634460",
            "telephone_number": "917-495-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 SEDGWICK AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104634460",
            "telephone_number": "917-495-1000",
            "fax_number": "917-495-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVITIASHVILI",
        "first_name": "NODARI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-11",
        "last_updated": "2013-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "0483091",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "010921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01975048",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NODARI",
            "last_name": "DAVITI",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Vanessa Marcia Davis, FNP-BC
• Vivian Davis, LPN
• William Todd Davis, PHD
• Yonette Davis, MD
• Yvonne V Davis, LCSW
• Michelle M Davitt, MD
• Vahid Davoudi, MD
• Samantha Davy, FNP
• Sharon R Davy
• Shyyella Davy, CD (DTI), CLC

• General Practice Dentistry in Bronx, NY
• Providers in Bronx, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.