Kyle Robert Smith, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10067 Issued in TN

Practice address

111 Peacock CT
Seymour, TN 37865-5086

Phone

(865) 573-0274

NPI assigned

Jun 4, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beaver Creek Dental PLLC

  • Dental Clinic/Center
  • Knoxville, TN
  • NPI 1518407766
  NPD (past) Authorized official

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433376000000",
    "number": "1073993952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 PEACOCK CT",
            "city": "SEYMOUR",
            "state": "TN",
            "postal_code": "378655086",
            "telephone_number": "865-573-0274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PEACOCK CT",
            "city": "SEYMOUR",
            "state": "TN",
            "postal_code": "378655086",
            "telephone_number": "865-573-0274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KYLE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2015-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "10067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy Sizemore
• Skyview Medical Center
• Samantha Slagle, B.A.
• Cathy C. Smith, DDS
• Douglas G. Smith, DDS
• Phyllis C Smith, FNP
• Whitaker Michael Smith, MD
• Smokey Mountain Adult Care
• Smoky Mountain in-Home Care, LLC
• Smoky Mountain Mental Health, LLC

• General Practice Dentistry in Seymour, TN
• Providers in Seymour, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.