Gordon Bruce Davis, M.D., D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4915 Issued in WA

Practice address

1111 Pacific Ave
Ste 1
Everett, WA 98201-4200

Phone

(425) 348-1382

Fax

(425) 903-4402

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462406400000",
    "number": "1477641041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9810 MARINE VIEW DR",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982754110",
            "telephone_number": "425-348-1382",
            "fax_number": "425-903-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 PACIFIC AVE",
            "address_2": "STE 1",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014200",
            "telephone_number": "425-348-1382",
            "fax_number": "425-903-4402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GORDON",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "M.D., D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2016-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "4915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON DENTAL SERVICE",
            "identifier": "5161",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "21701",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "DE00004915",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE NUMBER",
            "identifier": "14666",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan David
• Stephanie Davidson
• Barbara Anne Davies, N.D.
• Riannin Davies
• Geoffrey C Davis, MD
• Jacey Davis
• Jennifer Arpin Davis, RD, CD
• Jesse James Davis
• Kaitlin Davis, LMHC
• Karine Janell Davis, ARNP

• Oral and Maxillofacial Surgery (Dentist) in Everett, WA
• Providers in Everett, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2016; 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.