Active NPI
Daniella Davis
- Orthodontics and Dentofacial Orthopedics Dentistry
- Lake Ronkonkoma, NY
National Provider Identifier
1508471665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 061059
- Practice address
- 500 Portion Rd Ste 15
Lake Ronkonkoma, NY 11779-4587 - Phone
- (631) 588-1199
- NPI assigned
- Sep 14, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 061059 | NY | Primary |
Addresses
Primary practice location
500 Portion Rd Ste 15
Lake Ronkonkoma, NY 11779-4587
Mailing address
500 Portion Rd Ste 15
Lake Ronkonkoma, NY 11779-4587
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 |
|---|---|---|---|
| 061059 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600041600000",
"number": "1508471665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 PORTION RD STE 15",
"city": "LAKE RONKONKOMA",
"state": "NY",
"postal_code": "117794587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 PORTION RD STE 15",
"city": "LAKE RONKONKOMA",
"state": "NY",
"postal_code": "117794587",
"telephone_number": "631-588-1199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "DANIELLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-14",
"last_updated": "2020-09-14",
"certification_date": "2020-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NY",
"license": "061059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Ronkonkoma, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.