Jefferson Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DS0000003187 Issued in TN

Legal business name

JEFFERSON DENTAL

Practice address

1205 George Ave
Jefferson City, TN 37760-2759

Phone

(865) 475-8988

Fax

(865) 475-1103

NPI assigned

Jun 5, 2012

Last updated

Jun 5, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Donna B Fairbanks

Title

Office Manager

Phone

(865) 475-8988

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Walter Stuart Tipton, DDS

  • General Practice Dentistry
  • Jefferson City, TN
  • NPI 1982616694
  NPD (past)

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

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338854400000",
    "number": "1083975221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 GEORGE AVE",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "377602759",
            "telephone_number": "865-475-8988",
            "fax_number": "865-475-1103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 GEORGE AVE",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "377602759",
            "telephone_number": "865-475-8988",
            "fax_number": "865-475-1103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-05",
        "last_updated": "2012-06-05",
        "status": "A",
        "authorized_official_last_name": "FAIRBANKS",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "865-475-8988",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TN",
            "license": "DS0000003187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jefferson City Operations, LLC (Life Care Center of Jefferson City)
• Jefferson City Senior Center
• Jefferson County EMS
• Jefferson County Hma LLC (Tennova Healthcare-Jefferson Memorial Hospital)
• Jefferson County Hma, LLC (Tennova Healthcare-Jefferson Memorial Hospital)
• Jefferson Family Physicians P C
• Jefferson Hearts Consultants
• Jefferson Operator LLC (Jefferson City Health & Rehab Center)
• Jefferson Pulmonary Group
• Kelsey Jenkins, FNP-C

• Dental Clinic/Center in Jefferson City, TN
• Providers in Jefferson City, TN by specialty
• Dental Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; 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.