Sisco Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SISCO FAMILY DENTISTRY

Practice address

240 Central Ave. West
Jamestown, TN 38556-0884

Phone

(931) 879-9544

Fax

(931) 879-0844

NPI assigned

Oct 3, 2013

Organization subpart

Yes

Parent organization

SISCO FAMILY DENTISTRYAs reported in NPPES

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

Authorized official

Name

Travis W Sisco, DDS

Title

Owner

Phone

(931) 879-9544

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jamestown Family Dentistry Doing business as

Part of

Sisco Family Dentistry

Locations

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380758400000",
    "number": "1275960312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 884",
            "city": "JAMESTOWN",
            "state": "TN",
            "postal_code": "385560884",
            "telephone_number": "931-879-9544",
            "fax_number": "931-879-0844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 CENTRAL AVE. WEST",
            "city": "JAMESTOWN",
            "state": "TN",
            "postal_code": "385560884",
            "telephone_number": "931-879-9544",
            "fax_number": "931-879-0844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISCO FAMILY DENTISTRY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SISCO FAMILY DENTISTRY",
        "enumeration_date": "2013-10-03",
        "last_updated": "2013-10-03",
        "status": "A",
        "authorized_official_last_name": "SISCO",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-879-9544",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528728",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jamestown Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Travis Allen Rich, APRN
• David Baldwin Robertson, DDS
• Laquita Lynne Sandman, NP
• Micah Sellew
• Christopher Samuel Sewell, M.D.
• Jennifer Smith
• Jordan D Smith, O.D.
• Kelvin Russell Smith II, PT, DPT
• Kristin Smith
• Misty Dawn Smith

• General Practice Dentistry in Jamestown, TN
• Providers in Jamestown, 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 Oct 3, 2013; 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.