John Albert Smith, DDS PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

185279 Issued in MS

Practice address

910 Medallion Dr
Greenwood, MS 38930-2118

Phone

(662) 455-9149

Fax

(662) 453-1495

NPI assigned

Sep 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. John Albert Smith Jr. Former name

Medicare fee-for-service enrollment

Enrolled in MS

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205929684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 MEDALLION DR",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389302118",
            "telephone_number": "662-455-9149",
            "fax_number": "662-453-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 MEDALLION DR",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389302118",
            "telephone_number": "662-455-9149",
            "fax_number": "662-453-1495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JOHN",
        "middle_name": "ALBERT",
        "name_prefix": "Dr.",
        "credential": "DDS PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "185279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "SMITH",
            "middle_name": "ALBERT",
            "prefix": "DR.",
            "suffix": "JR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charles S. Small, PH.D.
• Rebecca Small
• Barbara H Smith, MD
• Bramya Smith
• Brandy G Smith, FNP-BC
• Joyce Smith, FNP
• Laporsha Danette Smith, PHARMD
• Lisa Stuart Smith, PHARM.D.
• Ralph Arnold Smith Jr., M.D.
• Susan Noelle Smith, DPT

• General Practice Dentistry in Greenwood, MS
• Providers in Greenwood, MS by specialty
• General Practice Dentistry in Mississippi

• 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.
• 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.