DUSTIN MICHAEL DAVIS D.D.S.
NPI 1063787497
Dentist - Pediatric Dentistry in Clackamas, OR

Q: What is Dustin Davis's NPI number?

The NPI number for Dustin Davis is 1063787497. It was assigned to this individual provider in the NPPES registry on March 19, 2012.

Q: What is Dustin Davis's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Q: When was this NPI record last updated?

The NPPES record for Dustin Davis was last updated on June 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 19, 2012PECOS Enrolled

11411 SE SUNNYSIDE RD STE 101, CLACKAMAS, OR 97015(503) 855-5100 Get Directions Write a Review

NPPES record last updated: June 30, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 30, 2021, May 1, 2018 (2 updates tracked since 2018).

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About Dustin Michael Davis D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DUSTIN MICHAEL DAVIS D.D.S. (NPI 1063787497) is an individual pediatric dentistry provider in Clackamas, Oregon, licensed in Oregon (D11447) and active in the NPI registry since March 2012. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063787497

Entity TypeIndividualMale

Primary Taxonomy1223P0221X

Provider Legal NameDUSTIN MICHAEL DAVISCredential: D.D.S.

Location Address11411 SE SUNNYSIDE RD STE 101Clackamas, OR 97015-9356

Mailing Address11411 Se Sunnyside Rd Ste 101Clackamas, OR 97015-9356 · (951) 526-5452

Phone(503) 855-5100

Sole ProprietorNo

Enumeration DateMarch 19, 2012

Last NPPES UpdateJune 30, 20212 updates tracked since enumeration

NPPES CertifiedJune 30, 2021

✔ NPI 1063787497 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

Licenses✔ Licensed in OR · D11447✔ Licensed in WA · DE60650351

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Also ListedDentistTaxonomy 122300000X · License 019029333 (IL), DEN.00202313 (CO)

11411 SE SUNNYSIDE RD STE 101, Clackamas, OR 97015

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dustin Michael Davis D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97015 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.51 typical visit price

range $58.99 – $176.88

Typical copayment $22.62 (range $14.74 – $44.22)

Most-billed visit code 99203

Established Patient

$73.28 typical visit price

range $19.32 – $144.79

Typical copayment $18.32 (range $4.83 – $36.19)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dustin Davis's NPI number?

The NPI number for Dustin Davis is 1063787497. It was assigned to this individual provider in the NPPES registry on March 19, 2012.

Where is Dustin Davis located?

Dustin Davis practices at 11411 SE Sunnyside Rd Ste 101, Clackamas, OR 97015. The listed phone number is (503) 855-5100.

What is Dustin Davis's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Dustin Davis enrolled in Medicare?

Yes. Dustin Davis is registered in the Medicare PECOS enrollment system.

What insurance does Dustin Davis accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 8 other insurers list Dustin Davis as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Dustin Davis was last updated on June 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.