Glen Sanford Davis, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3205 Issued in ME

Practice address

16 Bristol Road
Damariscotta, ME 04543

Phone

(207) 563-5203

Fax

(207) 563-7383

NPI assigned

Apr 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972722585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 BRISTOL ROAD",
            "address_2": "P.O. BOX 387",
            "city": "DAMARISCOTTA",
            "state": "ME",
            "postal_code": "04543",
            "telephone_number": "207-563-5203",
            "fax_number": "207-563-7383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 BRISTOL ROAD",
            "city": "DAMARISCOTTA",
            "state": "ME",
            "postal_code": "04543",
            "telephone_number": "207-563-5203",
            "fax_number": "207-563-7383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GLEN",
        "middle_name": "SANFORD",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "3205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn D. Czyz, CRNA
• Carl P D'Amato, MD
• Damariscotta
• Damariscotta Chiropractic
• Damariscotta Chiropractic
• Kathryn D Davis, DPT
• Lisa Susan Davis, CRNA, APRN
• Cathy Davison
• Misti Day, APRN-FNP-C
• Lisa Marie Dayringer

• General Practice Dentistry in Damariscotta, ME
• Providers in Damariscotta, ME by specialty
• General Practice Dentistry in Maine

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.