NPIMap

Organization Active NPI

CD Tennessee Dental, P.C.

Doing business as Radiant Smiles Dentistry

  • General Practice Dentistry
  • Madison, TN
National Provider Identifier
1083263586
Registry record updated May 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CD TENNESSEE DENTAL, P.C.
Doing business as
Radiant Smiles Dentistry
Practice address
103 Cude LN
Madison, TN 37115-2201
Phone
(615) 851-7999
Fax
(615) 851-8491
NPI assigned
Sep 6, 2019
Last updated
May 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2023

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

Authorized official

Name
Ty Justice
Title
Director, Payer Relations
Phone
(513) 808-4984

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

103 Cude LN
Madison, TN 37115-2201

Mailing address

9825 Kenwood Rd Ste 200
Blue Ash, OH 45242-6252
Phone (513) 808-4984

Other names 1

  • Radiant Smiles Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CD Tennessee Dental PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

103 Cude Ln
Madison, TN 37115
Phone (615) 766-8017

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1083263586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9825 KENWOOD RD STE 200",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426252",
            "telephone_number": "513-808-4984",
            "fax_number": "513-448-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 CUDE LN",
            "city": "MADISON",
            "state": "TN",
            "postal_code": "371152201",
            "telephone_number": "615-851-7999",
            "fax_number": "615-851-8491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CD TENNESSEE DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-06",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "TY",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "513-808-4984"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Radiant Smiles Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; 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.