Active NPI
Dylan Gray Qualls, DDS
- General Practice Dentistry
- Crossville, TN
National Provider Identifier
1013584564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11556
- Practice address
- 66 West Ave
Crossville, TN 38555-4773 - Phone
- (931) 200-8626
- NPI assigned
- Jun 4, 2021
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11556 | TN | Primary |
Addresses
Primary practice location
66 West Ave
Crossville, TN 38555-4773
Mailing address
66 West Ave
Crossville, TN 38555-4773
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 |
|---|---|---|---|
| 11556 | TN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622764800000",
"number": "1013584564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 WEST AVE",
"city": "CROSSVILLE",
"state": "TN",
"postal_code": "385554773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 WEST AVE",
"city": "CROSSVILLE",
"state": "TN",
"postal_code": "385554773",
"telephone_number": "931-200-8626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUALLS",
"first_name": "DYLAN",
"middle_name": "GRAY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-04",
"last_updated": "2021-06-04",
"certification_date": "2021-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TN",
"license": "11556",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crossville, TN
- Steven Pribanich, MD
- Wanda Jean Price, APN, FNP-C
- William Matthew (Matt) Pugh, D.O.
- Putnam County Orthopedic Appliance Co., Inc.
- Quality Medical Center, PC
- Karina Noel Qualmann
- Tammy Frances Quibell Greenfield, APRN, FNP-C
- Brandon Quillen, PHARM.D.
- Quirk and Wheeler Orthodontics PLLC
- Lacey McDonough Raburn, MS, RD, CLC, LDN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.