Active NPI
Samuel E Deatherage, DMD
- Dentist
- Athens, AL
National Provider Identifier
1073686424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5983
- Practice address
- 110 College St
Suite D
Athens, AL 35611-2714 - Phone
- (256) 232-0789
- Fax
- (256) 232-5247
- NPI assigned
- Nov 15, 2006
- Last updated
- Apr 17, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 5983 | AL | Primary |
Addresses
Primary practice location
110 College St
Suite D
Athens, AL 35611-2714
Mailing address
110 College St
Suite D
Athens, AL 35611-2714
Phone (256) 232-0789
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 |
|---|---|---|---|
| 5983 | AL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alabama Dental Professionals, PC | Dentist | 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.
-
dba Valley Smiles Dental Care
- General Practice Dentistry
- Athens, AL
- NPI 1013249242
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366156800000",
"number": "1073686424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 COLLEGE ST",
"address_2": "SUITE D",
"city": "ATHENS",
"state": "AL",
"postal_code": "356112714",
"telephone_number": "256-232-0789",
"fax_number": "256-232-5247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 COLLEGE ST",
"address_2": "SUITE D",
"city": "ATHENS",
"state": "AL",
"postal_code": "356112714",
"telephone_number": "256-232-0789",
"fax_number": "256-232-5247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEATHERAGE",
"first_name": "SAMUEL",
"middle_name": "E",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2013-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AL",
"license": "5983",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, AL
- Kaylie Beth Davis, CNA
- Tiffany L Davis, PT
- William A Davis, DMD
- Morgan Todd Dean, CRNP
- Randall L Dearment, D.O.
- William Christopher Deneke, LPC
- Jill C Denney, PHARM.D.
- Dental Associates of Athens, LLC
- Diagnostic Health MRI of Gadsden, LLC (Outpatient Diagnostic Center of Athens)
- Dianna G Osborn MD PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.