Stefanie Katrina Davis, DDS
Individual provider Active NPI Dentist · Hogansburg, NY
NPI 1922636992 · NPPES record last updated Sep 24, 2021
Key facts
- NPI
- 1922636992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 061711 (NY)
- Practice address
- Saint Regis Mohawk Tribe Health Services
404 State Route 37
Hogansburg, NY 13655 - Phone
- (518) 358-3141
- Fax
- (518) 358-9175
- NPI assigned
- Mar 27, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220118002133 | NY | Practitioner - Dentist | 9335531615 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 061711 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Regis Mohawk Tribe | Current |
Accepting new patients |
Locations
412 State Route 37
Hogansburg, NY 13655
Phone (518) 358-3141
404 State Route 37
Hogansburg, NY 13655
Phone (518) 358-3141
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 061711 | NY | Yes |
Addresses
Primary practice location
Saint Regis Mohawk Tribe Health Services
404 State Route 37
Hogansburg, NY 13655
Mailing address
404 State Route 37
Hogansburg, NY 13655
Phone (518) 358-3141
Other providers in Hogansburg, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.