Active NPI
Brandon Davison, DDS
- General Practice Dentistry
- Fort Campbell, KY
National Provider Identifier
1902535032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12537
- Practice address
- 650 Joel Dr
Fort Campbell, KY 42223-8355 - Phone
- (270) 798-8400
- NPI assigned
- Jun 6, 2022
- Sex
- Male
- 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 | 12537 | TN | Primary |
Addresses
Primary practice location
650 Joel Dr
Fort Campbell, KY 42223-8355
Mailing address
650 Joel Dr
Fort Campbell, KY 42223-8355
Other practice location 1
330 Pageant Ln
Clarksville, TN 37040-3854
Phone (931) 648-7261
Other practice location 2
3455 Lawrenceville Hwy
Lawrenceville, GA 30044-4101
Phone (478) 972-5773
Other practice location 3
651 S New Ballas Road
St Louis, MO 63141
Phone (314) 251-6000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220709000615 | MO | Order and Referring Only - Dentist | 6901286806 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN123011 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789084800000",
"number": "1902535032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422238355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422238355",
"telephone_number": "270-798-8400"
}
],
"practiceLocations": [
{
"address_1": "330 Pageant Ln",
"address_purpose": "LOCATION",
"city": "Clarksville",
"state": "TN",
"postal_code": "370403854",
"country_code": "US",
"telephone_number": "931-648-7261",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3455 Lawrenceville Hwy",
"address_purpose": "LOCATION",
"city": "Lawrenceville",
"state": "GA",
"postal_code": "300444101",
"country_code": "US",
"telephone_number": "478-972-5773",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "651 S New Ballas Road",
"address_purpose": "LOCATION",
"city": "St Louis",
"state": "MO",
"postal_code": "63141",
"country_code": "US",
"telephone_number": "314-251-6000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVISON",
"first_name": "BRANDON",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-06",
"last_updated": "2026-09-11",
"certification_date": "2026-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TN",
"license": "12537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; 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.