Randall Paris Prince, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS3389 Issued in TN

Practice address

427 Troy Ave
Dyersburg, TN 38024-3947

Phone

(731) 286-1583

Fax

(731) 287-9881

NPI assigned

Feb 15, 2007

Last updated

Mar 28, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 10, 2015 through Mar 10, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elite Dental Care Dyersburg

  • Dental Clinic/Center
  • Dyersburg, TN
  • NPI 1801521604
  NPD (past)

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490659200000",
    "number": "1154464519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 TROY AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243947",
            "telephone_number": "731-286-1583",
            "fax_number": "731-287-9881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 TROY AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243947",
            "telephone_number": "731-286-1583",
            "fax_number": "731-287-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRINCE",
        "first_name": "RANDALL",
        "middle_name": "PARIS",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2017-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS3389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "0041537",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerry Edward Presley, PT
• Prewitt Medical Care Clinic PC
• Darrion Jewayne Prewitt, MD
• Jason C Price, PHARMD
• Karen Dawn Priest, PTA
• Proactive MD, LLC
• Professional Care Services of West TN Inc (PCS Dyersburg Counseling Center)
• Professional Care Services of West TN, Inc.
• Professional Sonographic Imaging
• PT Company

• General Practice Dentistry in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.