Organization Active NPI

Simple Smiles, P.C.

  • General Practice Dentistry
  • Johnson City, TN
National Provider Identifier
1336893163
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SIMPLE SMILES, P.C.
Practice address
712 W Walnut St
Johnson City, TN 37604-6524
Phone
(423) 218-0968
NPI assigned
Feb 10, 2022
Last updated
Feb 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Authorized official

Name
Ben Cutler
Title
Secretary
Phone
(607) 743-9474

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU
Endodontics 1223E0200X NU
General Practice Dentistry 1223G0001X NU Primary
Periodontics 1223P0300X NU
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU

Addresses

Primary practice location

712 W Walnut St
Johnson City, TN 37604-6524

Mailing address

296 S Main St Ste 300
Alpharetta, GA 30009-1973

National Provider Directory

National Provider Directory

Locations

712 W Walnut St
Johnson City, TN 37604
Phone (423) 218-0968

NPI Registry JSON

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

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1336893163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 S MAIN ST STE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300091973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 W WALNUT ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046524",
            "telephone_number": "423-218-0968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPLE SMILES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-10",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "CUTLER",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "607-743-9474"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.