Jack Brian Smith, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

DN012910 Issued in GA

Practice address

160 Three Rivers Dr NE
Ste. 1600
Rome, GA 30161-2303

Phone

(706) 291-0095

Fax

(706) 291-0036

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356489462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 DOVER DR SE",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301618015",
            "telephone_number": "423-309-6816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 THREE RIVERS DR NE",
            "address_2": "STE. 1600",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301612303",
            "telephone_number": "706-291-0095",
            "fax_number": "706-291-0036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACK",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "DN012910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Smith-Ludvik, RBT
• Alicia Louise Smith, CPNP
• Demetrias Racquel Smith, RN
• Elizabeth Anne Smith, M.D
• Gary Locke Smith, O.D.
• Jason L Smith, M D
• Julia Diane Smith
• Justin Smith, M.D.
• Kenneth Leroy Smith Sr., LPC014651
• Mary Katherine Smith, FNP-C

• Endodontics in Rome, GA
• Providers in Rome, GA by specialty
• Endodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.