Active NPI
Timothy Jose Smith, D.D.S.
- Dentist
- Albuquerque, NM
National Provider Identifier
1144313883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD2781
- Practice address
- 717 Encino PL NE Ste 6
Albuquerque, NM 87102-2624 - Phone
- (505) 247-8005
- Fax
- (505) 843-5893
- NPI assigned
- Oct 2, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DD2781 | NM | Primary |
Addresses
Primary practice location
717 Encino PL NE Ste 6
Albuquerque, NM 87102-2624
Mailing address
500 Barnett Rd
Bosque Farms, NM 87068-8145
Phone (505) 869-2307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56075367 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180413001669 | NM | Order and Referring Only - Dentist | 0446513998 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD2781 | NM | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323216000000",
"number": "1144313883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 BARNETT RD",
"city": "BOSQUE FARMS",
"state": "NM",
"postal_code": "870688145",
"telephone_number": "505-869-2307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "717 ENCINO PL NE STE 6",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871022624",
"telephone_number": "505-247-8005",
"fax_number": "505-843-5893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "TIMOTHY",
"middle_name": "JOSE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2011-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD2781",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "56075367",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; 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.