Active NPI
Miriam Walker
- Pediatric Dentistry
- Clarksville, TN
National Provider Identifier
1235620097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DS0000011302
- Practice address
- 495 Dunlop LN Ste 112
Clarksville, TN 37040-5296 - Phone
- (931) 221-0050
- NPI assigned
- May 28, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DS0000011302 | TN | Primary |
Addresses
Primary practice location
495 Dunlop LN Ste 112
Clarksville, TN 37040-5296
Mailing address
1134 Lamont CT
Clarksville, TN 37042-4715
Phone (931) 338-7494
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS0000011302 | TN | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spark Dental TN, PLLC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Cumberland Pediatric Dentistry
- Orthodontics and Dentofacial Orthopedics Dentistry
- Smyrna, TN
- NPI 1154087120
Pediatric Dentistry
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696377600000",
"number": "1235620097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1134 LAMONT CT",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370424715",
"telephone_number": "931-338-7494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "495 DUNLOP LN STE 112",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370405296",
"telephone_number": "931-221-0050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKER",
"first_name": "MIRIAM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-28",
"last_updated": "2023-10-04",
"certification_date": "2023-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TN",
"license": "DS0000011302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.