John Jackson Davis, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

0401006782 Issued in VA

Practice address

23 Fayette St
Martinsville, VA 24112-2703

Phone

(276) 632-7727

Fax

(276) 632-4397

NPI assigned

Nov 19, 2008

Last updated

Jan 23, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Martinsville Henry County Coalition for Health and Wellness

  dba MHC Community Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Martinsville, VA
  • NPI 1164192266
  NPD (past)
• Martinsville Henry County Coalition for Health and Wellness

  dba Connect Health - Patrick

  • Federally Qualified Health Center (FQHC)
  • Stuart, VA
  • NPI 1619707221
  NPD (past)

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

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1548415433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6112 PETERS CREEK RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240194028",
            "telephone_number": "540-563-1660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 FAYETTE ST",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241122703",
            "telephone_number": "276-632-7727",
            "fax_number": "276-632-4397"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6112 Peters Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240194028",
            "country_code": "US",
            "telephone_number": "540-563-1660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JOHN",
        "middle_name": "JACKSON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-19",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401006782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danville Regional Medical Center, LLC (SOVAH Health Martinsville)
• David Graham M.D., LLC
• David W Roycroft MD Inc
• Michael Kevin David, DO
• Desiree Davis, FNP-C
• Troy Anthony Davis, MD
• Dayclinic
• Gregory S Deacon, CP
• Deanna Jo Williamson (Regional Health Services)
• Dana Trent Dehart, LPC

• Pediatric Dentistry in Martinsville, VA
• Providers in Martinsville, VA by specialty
• Pediatric Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.