NPIMap

Organization Active NPI

Richardsonfamilydentistry

  • Dentist
  • Somerville, TN
National Provider Identifier
1053583005
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS8118 Issued in TN
Legal business name
RICHARDSONFAMILYDENTISTRY
Practice address
17395 Highway 64
Somerville, TN 38068-6162
Phone
(901) 466-9833
NPI assigned
Mar 31, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

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

Authorized official

Name
Dr. Dwayne Richardson, M.D.
Title
Owner
Phone
(901) 466-9833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DS8118 TN Primary

Addresses

Primary practice location

17395 Highway 64
Somerville, TN 38068-6162

Mailing address

17395 Highway 64
Somerville, TN 38068-6162
Phone (901) 466-9833

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206921600000",
    "number": "1053583005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17395 HIGHWAY 64",
            "city": "SOMERVILLE",
            "state": "TN",
            "postal_code": "380686162",
            "telephone_number": "901-466-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17395 HIGHWAY 64",
            "city": "SOMERVILLE",
            "state": "TN",
            "postal_code": "380686162",
            "telephone_number": "901-466-9833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARDSONFAMILYDENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-31",
        "last_updated": "2008-03-31",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-466-9833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "DS8118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.