Gordon H Davis, DMD,DMSC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

047679-1 Issued in NY

Practice address

4161 Route 22
Plattsburgh, NY 12901-5883

Phone

(518) 563-0040

Fax

(518) 562-0632

NPI assigned

Jun 28, 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

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Oral Surgery

Education

Harvard Medical School, 1998

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Adirondack Periodontics PLLC

  • Dental Clinic/Center
  • Plattsburgh, NY
  • NPI 1689816274

  Periodontics

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1528096765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4161 ROUTE 22",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129015883",
            "telephone_number": "518-563-0040",
            "fax_number": "518-562-0632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4161 ROUTE 22",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129015883",
            "telephone_number": "518-563-0040",
            "fax_number": "518-562-0632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GORDON",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DMD,DMSC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "047679-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David P.Gorman, MD PC
• Martin A Davidson, M.D.
• Nancy Beth Davidson, RN
• Eileen E Davis Roesler, MS CCCA
• Barbara Davis-Meconi, R.N.
• Jerome Alfred Davis, M.D.
• Kelly L Davis, PT
• Robert Earle Davis
• Donald W. Davison, D.D.S.
• Jennifer Mercier De Goey, P.T.

• Periodontics in Plattsburgh, NY
• Providers in Plattsburgh, NY by specialty
• Periodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.