Adirondack Periodontics PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

047679-1 Issued in NY

Legal business name

ADIRONDACK PERIODONTICS PLLC

Practice address

4161 Route 22
Plattsburgh, NY 12901-5883

Phone

(518) 563-0040

Fax

(518) 562-0632

NPI assigned

Mar 30, 2009

Last updated

Apr 29, 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. Gordon H Davis, DMD, DMSCNPI 1528096765

Title

Owner

Phone

(518) 563-0040

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

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.

• Gordon H Davis, DMD,DMSC

  • Periodontics
  • Plattsburgh, NY
  • NPI 1528096765
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1238371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1689816274",
    "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": {
        "organization_name": "ADIRONDACK PERIODONTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-30",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-563-0040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, DMSC"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "047679-1",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Plattsburgh, NY
• Providers in Plattsburgh, NY by specialty
• Dental Clinic/Center 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.