Active NPI
Paul Frederic Davis, D.D.S.
- Dentist
- Loon Lake, WA
National Provider Identifier
1992940803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE00005119
- Practice address
- 40217 North Shore Dr.
Loon Lake, WA 99148-0765 - Phone
- (509) 233-9074
- NPI assigned
- Dec 5, 2008
- 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 | DE00005119 | WA | Primary |
Addresses
Primary practice location
40217 North Shore Dr.
Loon Lake, WA 99148-0765
Mailing address
PO Box 765
Loon Lake, WA 99148-0765
Phone (509) 233-9074
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5546205 | Medicaid | WA |
Other names 1
- Paul Frederic Davis
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 |
|---|---|---|---|
| DE00005119 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228435200000",
"number": "1992940803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 765",
"city": "LOON LAKE",
"state": "WA",
"postal_code": "991480765",
"telephone_number": "509-233-9074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40217 NORTH SHORE DR.",
"city": "LOON LAKE",
"state": "WA",
"postal_code": "991480765",
"telephone_number": "509-233-9074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "PAUL",
"middle_name": "FREDERIC",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-05",
"last_updated": "2008-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE00005119",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5546205",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PAUL",
"last_name": "DAVIS",
"middle_name": "FREDERIC",
"credential": "D.D.S.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Loon Lake, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.