Mark S. Davis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-019101 Issued in IL

Practice address

1761 S Naperville Rd
105
Wheaton, IL 60189-5846

Phone

(630) 668-6180

Fax

(630) 668-6441

NPI assigned

Dec 18, 2006

Last updated

May 13, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242172800000",
    "number": "1518020825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1761 S NAPERVILLE RD",
            "address_2": "105",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601895846",
            "telephone_number": "630-668-6180",
            "fax_number": "630-668-6441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 S NAPERVILLE RD",
            "address_2": "105",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601895846",
            "telephone_number": "630-668-6180",
            "fax_number": "630-668-6441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MARK",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2009-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-019101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol E. Davis-Serpas, LCPC
• Andria M Davis
• Christine Davis, LCPC
• Edward Britt Davis, PSY.D.
• Margaret Therese Davis
• Susan S Davis, LCPC
• Tonya Davis, MS.ED
• Wanda Davis
• Shaquese L Dawkins
• Raygen Day

• General Practice Dentistry in Wheaton, IL
• Providers in Wheaton, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; 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.

Verify at the official NPI Registry.