Brock Davidson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

103896 Issued in CA

Practice address

509 Main St
Diamond Springs, CA 95619-9105

Phone

(530) 621-1051

NPI assigned

Jul 18, 2019

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1962055921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MAIN ST",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199105",
            "telephone_number": "530-621-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MAIN ST",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199105",
            "telephone_number": "530-621-1051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "BROCK",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-18",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "103896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "AbovetheGate",
            "affiliation": "N",
            "address_1": "509 Main St",
            "city": "Diamond Springs",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956199105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emma Crowley
• Emma Curtiss, LCSW
• Nicoleta Danker, PA
• Jenyn Darnell, LMFT
• Ashley Davenport
• Denise Nina De Lange-Hansen
• Mitchell Delariva
• Danny Deluna
• Ewa Demianiuk, STUDENT
• Diamond Springs Dental

• Dentist in Diamond Springs, CA
• Providers in Diamond Springs, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.