S Adele Doherty

Primary specialty

DentistTaxonomy code 122300000X

License

4679 Issued in TN

Practice address

107 New Brick Church Pike
Suite C
Goodlettsville, TN 37072-1545

Phone

(615) 851-4744

NPI assigned

Jun 20, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Agboola Adesegun Adele-Doherty Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dentistry and Fastbraces PC

  • Dental Clinic/Center
  • Goodlettsville, TN
  • NPI 1528057254
  NPD (past) Authorized official

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213920000000",
    "number": "1003077108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 646",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371210646",
            "telephone_number": "615-851-4744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 NEW BRICK CHURCH PIKE",
            "address_2": "SUITE C",
            "city": "GOODLETTSVILLE",
            "state": "TN",
            "postal_code": "370721545",
            "telephone_number": "615-851-4744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "S",
        "middle_name": "ADELE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-20",
        "last_updated": "2008-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "4679",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DC",
            "license": "5475",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5870",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AGBOOLA",
            "last_name": "ADELE-DOHERTY",
            "middle_name": "ADESEGUN",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Luis Manuel Del Rio II, PTA
• Deme Corporation
• Dentistry and Fastbraces PC
• Victoria Dillehay, DDS
• Robin Disney, MS CCC-SLP
• Terrence J Doherty, M.D.
• Elliott Dombrosky
• Rochelle Doniz
• Nancy Crockett Donlon, RN
• Greice Dos Santos de Sa

• Dentist in Goodlettsville, TN
• Providers in Goodlettsville, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.

Verify at the official NPI Registry.