1. Home
  2. Directory
  3. New York
  4. Plattsburgh
  5. Dentist
  6. NPI Profile

DR. GORDON H DAVIS DMD,DMSC
NPI 1528096765
Dentist - Periodontics in Plattsburgh, NY

Active since June 28, 2006PECOS Enrolled
4161 ROUTE 22, PLATTSBURGH, NY 12901(518) 563-0040(518) 562-0632 Get Directions Write a Review

NPPES record last updated: April 29, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Gordon H Davis Dmd,dmsc NPPES

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

DR. GORDON H DAVIS DMD,DMSC (NPI 1528096765) is an individual periodontics provider in Plattsburgh, New York, licensed in New York (047679-1) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS and is a graduate of Harvard Medical School (1998).

NPPES Registry Identity

NPI1528096765
Entity TypeIndividualMale
Primary Taxonomy1223P0300X
Provider Legal NameDR. GORDON H DAVISCredential: DMD,DMSC
Location Address4161 ROUTE 22Plattsburgh, NY 12901-5883
Mailing Address4161 Route 22Plattsburgh, NY 12901-5883 · (518) 563-0040 · Fax (518) 562-0632
Phone(518) 563-0040
Fax(518) 562-0632
Sole ProprietorYes
Medical School CMSHarvard Medical SchoolGraduated 1998
Enumeration DateJune 28, 2006
Last NPPES UpdateApril 29, 2024
NPPES CertifiedApril 29, 2024
✔ NPI 1528096765 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in NY · 047679-1
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
4161 ROUTE 22, Plattsburgh, NY 12901
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Gordon H Davis Dmd,dmsc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7416005301
PECOS Enrollment IDI20090504000157
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.

Medicare Billing Reassignment

Medicare enrollment records show Gordon Davis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Adirondack Periodontics PLLC
Same address
Dental
4161 ROUTE 22
Plattsburgh, NY 12901
  • Reassigned Medicare billing, New York enrollment
NPI 1689816274 (518) 563-0040

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 12901 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
$84.93 typical visit price
range $54.87 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$68.57 typical visit price
range $17.54 – $136.14
Typical copayment $17.14 (range $4.38 – $34.03)
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.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADIRONDACK PERIODONTICS PLLC
Clinic/Center (Dental)
4161 ROUTE 22
PLATTSBURGH, NY 12901
Clinton County (518) 563-0040

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 Gordon Davis's NPI number?

The NPI number for Gordon Davis is 1528096765. It was assigned to this individual provider in the NPPES registry on June 28, 2006.

Where is Gordon Davis located?

Gordon Davis practices at 4161 Route 22, Plattsburgh, NY 12901. The listed phone number is (518) 563-0040.

What is Gordon Davis's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Gordon Davis enrolled in Medicare?

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

Which organization bills Medicare for Gordon Davis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Gordon Davis reassigns Medicare benefits to Adirondack Periodontics PLLC (Plattsburgh, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Gordon Davis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Gordon Davis was last updated on April 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.