NPIMap

Individual provider Active NPI

Tyler A Davis, DMD, MS

  • Endodontics
  • San Clemente, CA
National Provider Identifier
1548799661
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
106384 Issued in CA
Practice address
943 Avenida Pico Unit a
San Clemente, CA 92673-3914
Phone
(949) 366-9555
NPI assigned
Jun 12, 2017
Last updated
Jul 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 2019003577 MO
Endodontics 1223E0200X 106384 CA Primary

Addresses

Primary practice location

943 Avenida Pico Unit a
San Clemente, CA 92673-3914

Mailing address

3402 Calle Sin Rival
San Clemente, CA 92673-3821
Phone (702) 480-4256

Other practice location 1

2231 Michigan Ave
Arnold, MO 63010-2151
Phone (636) 287-1226

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)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Tyler Davis Dental Corporation Endodontics Current Accepting new patients
Buehler and Reagan Dental Corporation General Practice PastSince Aug 1, 2021 Accepting new patients
Alex Sharifian DDS Water Tower Dental Group PC General Practice Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1548799661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3402 CALLE SIN RIVAL",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926733821",
            "telephone_number": "702-480-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "943 AVENIDA PICO UNIT A",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926733914",
            "telephone_number": "949-366-9555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2231 Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Arnold",
            "state": "MO",
            "postal_code": "630102151",
            "country_code": "US",
            "telephone_number": "636-287-1226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "TYLER",
        "middle_name": "A",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-12",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MO",
            "license": "2019003577",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "106384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; 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.