Tyson Archer Davis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7815 Issued in AZ

Practice address

2028 N Trekell Rd Ste 107
Casa Grande, AZ 85122-1326

Phone

(520) 876-9955

NPI assigned

Jul 10, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Agave Dentistry

  • General Practice Dentistry
  • Casa Grande, AZ
  • NPI 1790959435
  NPD (past)

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

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536537600000",
    "number": "1770712820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 N TREKELL RD # 107-108",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851221326",
            "telephone_number": "520-876-9955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2028 N TREKELL RD STE 107",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851221326",
            "telephone_number": "520-876-9955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "TYSON",
        "middle_name": "ARCHER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-10",
        "last_updated": "2018-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D7815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• D Michael Dick, P.C.
• Darlene Doris Daniels
• Melissa Dasher, RN
• Germaine Davenport, CDM CFPP SNS CPFM
• Mirtha Davila
• David Gene Dawson, DC
• Dean B Clement, DPM, PLLC (Clement Foot and Ankle)
• Kerrie Lynn Decastro, CNM
• Catherine Decker, REGISTERED DIETITIAN
• Rosenberg Delgado, RDH AP

• General Practice Dentistry in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.