Active NPI
J Randall Smith, D.D.S.,M.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Tullahoma, TN
National Provider Identifier
1114917010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 179
- Practice address
- 205 S Jackson St
Tullahoma, TN 37388-4426 - Phone
- (931) 455-0146
- Fax
- (931) 393-3863
- NPI assigned
- Oct 24, 2005
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 179 | TN | Primary |
Addresses
Primary practice location
205 S Jackson St
Tullahoma, TN 37388-4426
Mailing address
205 S Jackson St
Tullahoma, TN 37388-4426
Phone (931) 455-0146
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 844210 | Other | UNITED CONCORDIA | |
| 0160873 | Other | TN | BLUE CROSS BLUE SHIELD |
| 0006684 | Other | DORAL DENTAL |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 179 | TN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS. Smith & Fewell, D.D.S.,M.S.,PC | Orthodontics and Dentofacial Orthopedics | 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 and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Tullahoma, TN
- NPI 1427047430
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114917010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 S JACKSON ST",
"city": "TULLAHOMA",
"state": "TN",
"postal_code": "373884426",
"telephone_number": "931-455-0146",
"fax_number": "931-393-3863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 S JACKSON ST",
"city": "TULLAHOMA",
"state": "TN",
"postal_code": "373884426",
"telephone_number": "931-455-0146",
"fax_number": "931-393-3863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "J",
"middle_name": "RANDALL",
"name_prefix": "Dr.",
"credential": "D.D.S.,M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TN",
"license": "179",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "844210",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0160873",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL DENTAL",
"identifier": "0006684",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Tullahoma, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.