NPIMap

Individual provider Active NPI

John B Smith Jr., DMD

  • General Practice Dentistry
  • Forest, MS
National Provider Identifier
1306996970
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1853 Issued in MS
Practice address
1040 Hwy 35 South
Forest, MS 39074
Phone
(601) 469-3851
Fax
(601) 469-4356
NPI assigned
Jan 12, 2007
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1853 MS Primary

Addresses

Primary practice location

1040 Hwy 35 South
Forest, MS 39074

Mailing address

P O Drawer 30
Forest, MS 39074
Phone (601) 469-3851

Other identifiers 1

IdentifierTypeStateIssuer
00064776MedicaidMS

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

LicenseStateTypeSpecialty
1853MSMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
John B. Smith, Jr. DMD, PA General Practice Past Accepting new patients
Forest Dental Practice PLLC General Practice Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jsmith113043@ummc.direct-ci.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1306996970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O DRAWER 30",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "39074",
            "telephone_number": "601-469-3851",
            "fax_number": "601-469-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 HWY 35 SOUTH",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "39074",
            "telephone_number": "601-469-3851",
            "fax_number": "601-469-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JOHN",
        "middle_name": "B",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "1853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00064776",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.