Samuel Davidson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1587 Issued in WY

Practice address

337 Greybull Ave
Greybull, WY 82426-2049

Phone

(307) 765-4654

Fax

(307) 333-0494

NPI assigned

Jun 11, 2021

Last updated

Sep 1, 2023By the provider in NPPES

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Samuel C Davidson DDS LLC

  • General Practice Dentistry
  • Greybull, WY
  • NPI 1841076288
  NPD
• Casper Mountain Dental Dba Advanced Family Dental

  • General Practice Dentistry
  • Casper, WY
  • NPI 1164147666
  NPD (past)

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1861060444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 GREYBULL AVE",
            "city": "GREYBULL",
            "state": "WY",
            "postal_code": "824262049",
            "telephone_number": "307-765-4654",
            "fax_number": "307-333-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "337 GREYBULL AVE",
            "city": "GREYBULL",
            "state": "WY",
            "postal_code": "824262049",
            "telephone_number": "307-765-4654",
            "fax_number": "307-333-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "SAMUEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-11",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WY",
            "license": "1587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Big Horn Drug
• Big Horn Nutrition, LLC
• Bighorn Valley Health Center Incorporated (One Health)
• County of Big Horn
• Ross A Davidson, PHARMD
• Tenika Leigh Eardley, RDN
• Melissa Jean Eckman, RN
• Eye Care for You, LLC
• First Flight of Wyoming LLC
• Lacey Ford

• General Practice Dentistry in Greybull, WY
• Providers in Greybull, WY by specialty
• General Practice Dentistry in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; 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.