Philip Paul Davern, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS021336L Issued in PA

Practice address

231 Chestnut St
Suite 202
Meadville, PA 16335-3442

Phone

(814) 724-4021

Fax

(814) 724-1193

NPI assigned

Oct 25, 2006

Last updated

Jul 8, 2007By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629153226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 CHESTNUT ST",
            "address_2": "SUITE 202",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163353442",
            "telephone_number": "814-724-4021",
            "fax_number": "814-724-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 CHESTNUT ST",
            "address_2": "SUITE 202",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163353442",
            "telephone_number": "814-724-4021",
            "fax_number": "814-724-1193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVERN",
        "first_name": "PHILIP",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS021336L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007528290001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Shane Alan Daugherty
• David A Davenport, CRNA
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• Debi Ann Davis, LPC
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• Martin Joseph Decker, D.O.

• General Practice Dentistry in Meadville, PA
• Providers in Meadville, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.