Active NPI
Samantha Jane Smallman, RDH
- Dental Hygienist
- Montgomery, WV
National Provider Identifier
1073330080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2857
- Practice address
- 410 4TH Ave
Montgomery, WV 25136-2105 - Phone
- (304) 442-2488
- NPI assigned
- Sep 21, 2024
- Last updated
- Sep 21, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2857 | WV | Primary |
Addresses
Primary practice location
410 4TH Ave
Montgomery, WV 25136-2105
Mailing address
1511 Village Dr
South Charleston, WV 25309-2431
Phone (304) 541-9897
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 |
|---|---|---|---|
| 2857 | WV | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kennedy Dental Office | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Montgomery, WV
- NPI 1447311451
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726876800000",
"number": "1073330080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1511 VILLAGE DR",
"city": "SOUTH CHARLESTON",
"state": "WV",
"postal_code": "253092431",
"telephone_number": "304-541-9897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 4TH AVE",
"city": "MONTGOMERY",
"state": "WV",
"postal_code": "251362105",
"telephone_number": "304-442-2488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALLMAN",
"first_name": "SAMANTHA",
"middle_name": "JANE",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-21",
"last_updated": "2024-09-21",
"certification_date": "2024-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WV",
"license": "2857",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.