Blue Ribbon Dental Center LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

8178 Issued in TN

Legal business name

BLUE RIBBON DENTAL CENTER LLC

Practice address

211 Church St
Tiptonville, TN 38079-1109

Phone

(731) 253-9091

NPI assigned

Mar 27, 2008

Last updated

Mar 27, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Denean Reshay Carr

Title

Dentist

Phone

(731) 253-9091

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206576000000",
    "number": "1366614588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 375",
            "city": "TIPTONVILLE",
            "state": "TN",
            "postal_code": "380790375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 CHURCH ST",
            "city": "TIPTONVILLE",
            "state": "TN",
            "postal_code": "380791109",
            "telephone_number": "731-253-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIBBON DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-27",
        "last_updated": "2008-03-27",
        "status": "A",
        "authorized_official_last_name": "CARR",
        "authorized_official_first_name": "DENEAN",
        "authorized_official_middle_name": "RESHAY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "731-253-9091",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "TN",
            "license": "8178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4120836",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9176548",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charlotte Corkran Adcock, PHARMACIST
• Misty C Barker, APN
• Astin Berry, PTA
• Daniel W. Bruce, M.D.
• Cinderella Wigs & Breast Prosthetics
• Citizens of Lake County for Health Care Inc (Lake County Primary Care)
• Amanda Collins, PA-C
• County of Lake (Lake County Emergency Medical Service)

• Health Maintenance Organization in Tiptonville, TN
• Providers in Tiptonville, TN by specialty
• Health Maintenance Organization in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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.