NPIMap

Organization Active NPI

Randalll Davis MDM PC

  • Dentist
  • Somerville, MA
National Provider Identifier
1932530656
Registry record updated Dec 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN1856426 Issued in MA
Legal business name
RANDALLL DAVIS MDM PC
Practice address
14 Myrtle St
Somerville, MA 02145-4312
Phone
(857) 498-1353
NPI assigned
Dec 5, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Reyna E Gonzalez
Title
Office Manager
Phone
(978) 686-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN1856426 MA Primary

Addresses

Primary practice location

14 Myrtle St
Somerville, MA 02145-4312

Mailing address

14 Myrtle St
Somerville, MA 02145-4312
Phone (857) 498-1353

National Provider Directory

National Provider Directory
Tax ID family
Randall L Davis DMD PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1386201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386201600000",
    "number": "1932530656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MYRTLE ST",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021454312",
            "telephone_number": "857-498-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MYRTLE ST",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021454312",
            "telephone_number": "857-498-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALLL DAVIS MDM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-05",
        "last_updated": "2013-12-05",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "REYNA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "978-686-8500"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1856426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2013; 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.