Active NPI
Richard Allen Jeter, DMD
- Public Health Dentistry
- Campbellsville, KY
National Provider Identifier
1003220526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- 5355
- Practice address
- 230 Warren PL
Campbellsville, KY 42718-9618 - Phone
- (270) 789-2087
- NPI assigned
- Jun 12, 2014
- 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 |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 5355 | KY | Primary |
Addresses
Primary practice location
230 Warren PL
Campbellsville, KY 42718-9618
Mailing address
230 Warren PL
Campbellsville, KY 42718-9618
Phone (270) 789-2087
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 |
|---|---|---|---|
| 5355 | KY | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402531200000",
"number": "1003220526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 WARREN PL",
"city": "CAMPBELLSVILLE",
"state": "KY",
"postal_code": "427189618",
"telephone_number": "270-789-2087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 WARREN PL",
"city": "CAMPBELLSVILLE",
"state": "KY",
"postal_code": "427189618",
"telephone_number": "270-789-2087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JETER",
"first_name": "RICHARD",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-12",
"last_updated": "2014-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "KY",
"license": "5355",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Campbellsville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.