Michael Justin McNaught, D.D.S

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS0000009766 Issued in TN

Practice address

535 Bell Trace CT
Clarksville, TN 37040

Phone

(931) 999-7100

Fax

(931) 999-7101

NPI assigned

Jun 12, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO, TN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Liberty Oral and Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Clarksville, TN
  • NPI 1548834963

  Oral and Maxillofacial Surgery, TN

  Medicare reassignment NPD Authorized official
• Julie Becker, DDS, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Springfield, MO
  • NPI 1689642308

  MO, Oral and Maxillofacial Surgery

  Medicare reassignment NPD

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1124222435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 BELL TRACE CT",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37043",
            "telephone_number": "932-999-7100",
            "fax_number": "931-999-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 BELL TRACE CT",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37040",
            "telephone_number": "931-999-7100",
            "fax_number": "931-999-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNAUGHT",
        "first_name": "MICHAEL",
        "middle_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2021-11-18",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "2007015579",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS0000009766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q015358",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina Hughes McMillan, RN
• Daran Shania McMillen, RDN, LD
• Jada McMillian
• Stephanie Jane McMurry, R.D.
• Cassidi McNally, MSCJ
• Kevin P McNeeley, PHYSICIAN ASSISTANT
• Alyssa Joy McNeely
• Lindsey McNeil
• Rebekah McNeilly
• Danielle Ann McRae, MS

• All providers in Clarksville, TN
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; 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.