Active NPI
Duane Allen Davis, D.M.D.
- Dentist
- Mount Vernon, IL
National Provider Identifier
1912929191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Practice address
- 1704 Jefferson Ave
Mount Vernon, IL 62864-4331 - Phone
- (618) 244-2440
- Fax
- (618) 244-0607
- NPI assigned
- Jul 24, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | IL | Primary |
Addresses
Primary practice location
1704 Jefferson Ave
Mount Vernon, IL 62864-4331
Mailing address
12107 E Idlewood Dr
Mount Vernon, IL 62864-8415
Phone (618) 242-0915
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 |
|---|---|---|---|
| 019-022351 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912929191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12107 E IDLEWOOD DR",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628648415",
"telephone_number": "618-242-0915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1704 JEFFERSON AVE",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628644331",
"telephone_number": "618-244-2440",
"fax_number": "618-244-0607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "DUANE",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.