Active NPI
Tyler Davis, DMD
- Pediatric Dentistry
- San Mateo, CA
National Provider Identifier
1790096154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DDS61391
- Practice address
- 50 S San Mateo Dr Ste 160
San Mateo, CA 94401-3859 - Phone
- (650) 375-8300
- NPI assigned
- Jun 30, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1855461 | MA | |
| Pediatric Dentistry | 1223P0221X | DDS61391 | CA | Primary |
Addresses
Primary practice location
50 S San Mateo Dr Ste 160
San Mateo, CA 94401-3859
Mailing address
50 S San Mateo Dr Ste 160
San Mateo, CA 94401-3859
Phone (650) 375-8300
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 |
|---|---|---|---|
| DN1855461 | MA | MD | Dentist |
| DDS61391 | CA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peninsula Pediatric Dental Practice | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- San Mateo, CA
- NPI 1639590003
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639094400000",
"number": "1790096154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 S SAN MATEO DR STE 160",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013859",
"telephone_number": "650-375-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 S SAN MATEO DR STE 160",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013859",
"telephone_number": "650-375-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "TYLER",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-30",
"last_updated": "2021-12-10",
"certification_date": "2021-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1855461",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "DDS61391",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.