NPIMap

Organization Active NPI

Hermitage Pediatric Dentistry

  • Dental Clinic/Center
  • Hermitage, TN
National Provider Identifier
1174852958
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
8202 Issued in TN
Legal business name
HERMITAGE PEDIATRIC DENTISTRY
Practice address
107 Bonnabrook Dr
Hermitage, TN 37076-1910
Phone
(615) 889-1654
Fax
(615) 316-9197
NPI assigned
Dec 8, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

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

Authorized official

Name
Dr. Kirkland E Larson, D.D.SNPI 1265537427
Title
Dentist
Phone
(615) 889-1654

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 8202 TN Primary

Addresses

Primary practice location

107 Bonnabrook Dr
Hermitage, TN 37076-1910

Mailing address

107 Bonnabrook Dr
Hermitage, TN 37076-1910
Phone (615) 889-1654

National Provider Directory

National Provider Directory
Tax ID family
Hermitage Pediatric Dentistry3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

107 Bonnabrook Dr
Hermitage, TN 37076
Phone (615) 205-5956

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1260230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260230400000",
    "number": "1174852958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 BONNABROOK DR",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370761910",
            "telephone_number": "615-889-1654",
            "fax_number": "615-316-9197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 BONNABROOK DR",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370761910",
            "telephone_number": "615-889-1654",
            "fax_number": "615-316-9197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERMITAGE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-08",
        "last_updated": "2009-12-08",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "KIRKLAND",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "615-889-1654",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TN",
            "license": "8202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hermitage, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; 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.