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Deactivated NPI 1255588349 Deactivated / Inactive NPI Male Practitioner

Dr. John Robert Davidson , DDS

Dentist - General Practice • Peru, IN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. John Davidson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 20, 2008
NPI Deactivation Date August 07, 2025
Total Practice Duration ~17 Years of Practice (2008 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. John Davidson, DDS was a registered Dentist - General Practice practicing in Peru, IN. Throughout an active medical career spanning 17 years, Dr. Davidson provided care at the practice location at 27 N PARK AVE until profile deactivation on 2025-08-07.

Practice Location & Contact Primary Location

Practice Address

27 N Park Ave

Peru, IN 469701718

Telephone 7654754422

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Peru, IN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 14.3 Yrs
Regional Practice Density
6 Specialists

Practicing in Peru, IN (2204 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License IN 12007226A

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated August 07, 2025

Record deactivated on August 07, 2025

NPI Profile Active August 20, 2008

NPI status registered as active in NPPES database

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Updated Practice Location August 20, 2008

Registered at 27 N PARK AVE, PERU, IN 469701718 (Tel: 7654754422)

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Updated Business Mailing Address August 20, 2008

Registered at 27 N PARK AVE, PERU, IN 469701718 (Tel: 7654754422)

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Provider Name / Credentials Updated August 20, 2008

Recorded as JOHN DAVIDSON, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 20, 2008

Dentist (License #12007226A in IN)

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Initial NPI Registration & Enumeration August 20, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1255588349
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 20, 2008
Last Update: August 20, 2008
Deactivation Date: August 07, 2025

Mailing Address

27 N Park Ave

Peru, IN 469701718

Phone: 7654754422

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.