Davis Family Dental, SC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DAVIS FAMILY DENTAL, SC

Practice address

1201 Oak St Ste D
West Bend, WI 53095-3800

Phone

(262) 310-1860

Fax

(262) 310-1861

NPI assigned

Mar 18, 2024

Last updated

Mar 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tyler M Davis, DDSNPI 1154833044

Title

Owner

Phone

(262) 310-1860

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tyler Meadows Davis, DDS

  • General Practice Dentistry
  • West Bend, WI
  • NPI 1154833044
  NPD Authorized official

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1578322897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N161W20685 KAMI LN",
            "city": "JACKSON",
            "state": "WI",
            "postal_code": "530378937",
            "telephone_number": "262-622-1571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 OAK ST STE D",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530953800",
            "telephone_number": "262-310-1860",
            "fax_number": "262-310-1861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS FAMILY DENTAL, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-310-1860",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan L Daniels, DPT
• Kelly Jean Darmody, M.D.
• Darcy Jean Dart, SAC-IT
• Lori Jo Dauss, MS, ATC, LAT
• Debra L Dautermann, PT
• Denise Elizabeth Davis, MD
• Mary Davis, RN
• Tyler Meadows Davis, DDS
• Nora De Lise, D.P.T.
• Janice Marie De Smidt, MA CCC-SLP

• General Practice Dentistry in West Bend, WI
• Providers in West Bend, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.