NPIMap

Organization Active NPI

Tennessee Dental Professionals PC

  • General Practice Dentistry
  • Mount Juliet, TN
National Provider Identifier
1023313533
Registry record updated Sep 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TENNESSEE DENTAL PROFESSIONALS PC
Practice address
20 Old Pleasant Grove Road
Suite 100
Mount Juliet, TN 37122-3880
Phone
(615) 758-4807
NPI assigned
Jan 13, 2011
Organization subpart
Yes
Parent organization
TENNESSEE DENTAL PROFESSIONALS PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2014

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

Authorized official

Name
Kam Shick
Title
Insurance Coordinator
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

20 Old Pleasant Grove Road
Suite 100
Mount Juliet, TN 37122-3880

Mailing address

20 Old Pleasant Grove Road
Suite 100
Mount Juliet, TN 37122-3880
Phone (615) 758-4807

Other names 1

  • Paddock Place Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of TN PC66 organizations share this tax ID, including this one
Part of
Heartland Dental Care of TN PC

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Locations

20 Old Pleasant Grove Rd
Ste 100
Mt Juliet, TN 37122
Phone (615) 758-4807

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410912000000",
    "number": "1023313533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 OLD PLEASANT GROVE ROAD",
            "address_2": "SUITE 100",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371223880",
            "telephone_number": "615-758-4807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 OLD PLEASANT GROVE ROAD",
            "address_2": "SUITE 100",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371223880",
            "telephone_number": "615-758-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE DENTAL PROFESSIONALS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TENNESSEE DENTAL PROFESSIONALS PC",
        "enumeration_date": "2011-01-13",
        "last_updated": "2014-09-17",
        "status": "A",
        "authorized_official_last_name": "SHICK",
        "authorized_official_first_name": "KAM",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paddock Place Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Juliet, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.

Verify at the official NPI Registry.