Glendon W Smalley III, DMD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

DN014148 Issued in GA

Practice address

117 S Calhoun St
Dublin, GA 31021

Phone

(478) 353-3053

Fax

(478) 353-5311

NPI assigned

Apr 21, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Previously, effective Sep 9, 2020 through Sep 9, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Atlanta Oral & Facial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Marietta, GA
  • NPI 1992738165
  NPD (past)

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

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571356800000",
    "number": "1336466028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 S CALHOUN ST",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310215245",
            "telephone_number": "478-353-3053",
            "fax_number": "478-353-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 S CALHOUN ST",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "31021",
            "telephone_number": "478-353-3053",
            "fax_number": "478-353-5311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 J L Todd Dr",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301615048",
            "country_code": "US",
            "telephone_number": "706-235-5570",
            "fax_number": "706-235-5238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMALLEY",
        "first_name": "GLENDON",
        "middle_name": "W",
        "name_suffix": "III",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-21",
        "last_updated": "2019-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN014148",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "GA",
            "license": "DN014148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Irene Skinner Davis, RN
• SL SNF, LLC (Southland Healthcare and Rehabilitation Center)
• Andrew Slater, PA-C
• Keesha Sledge, SOCIAL WORKER
• Sleepmed Inc
• Glendon William Smalley, M.D.
• Rebecca Welch Smalley, RPH
• Oveta Smalls
• Madison Smiley, NP
• Smith Drugs LLC (Tomlinson Pharmacy)

• Oral & Maxillofacial Surgery (D.M.D.) in Dublin, GA
• Providers in Dublin, GA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.