Active NPI
Andrea L Davis, D.D.S.
- General Practice Dentistry
- D'Iberville, MS
National Provider Identifier
1750438255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3349-05
- Practice address
- 11505 Cinema Drive
Suite 6
D'Iberville, MS 39540 - Phone
- (228) 396-9000
- Fax
- (228) 396-9006
- NPI assigned
- Jan 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3349-05 | MS | Primary |
Addresses
Primary practice location
11505 Cinema Drive
Suite 6
D'Iberville, MS 39540
Mailing address
11505 Cinema Drive
Suite 6
D'Iberville, MS 39540
Phone (228) 396-9000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01524745 | Medicaid | MS |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3349-05 | MS | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331510400000",
"number": "1750438255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11505 CINEMA DRIVE",
"address_2": "SUITE 6",
"city": "D'IBERVILLE",
"state": "MS",
"postal_code": "39540",
"telephone_number": "228-396-9000",
"fax_number": "228-396-9006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11505 CINEMA DRIVE",
"address_2": "SUITE 6",
"city": "D'IBERVILLE",
"state": "MS",
"postal_code": "39540",
"telephone_number": "228-396-9000",
"fax_number": "228-396-9006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "ANDREA",
"middle_name": "L",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2012-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MS",
"license": "3349-05",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01524745",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in D'Iberville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.