Jerrold Wayne Smith, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019016584 Issued in IL

Practice address

2000 W. 95TH. Street
Chicago, IL 60643-1116

Phone

(773) 881-3920

Fax

(773) 881-4058

NPI assigned

Jan 4, 2007

Last updated

Apr 12, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jerrold W. Smith D.D.S.P.C.

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1730351891
  NPD (past) Authorized official
• School House Dental Service

  • Dentist
  • Chicago, IL
  • NPI 1104081884
  NPD (past) Authorized official

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1396892030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 W. 95TH. STREET",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431116",
            "telephone_number": "773-881-3910",
            "fax_number": "773-881-4058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 W. 95TH. STREET",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431116",
            "telephone_number": "773-881-3920",
            "fax_number": "773-881-4058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JERROLD",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010685",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019016584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019016584",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jazlynn Smith
• Jenna Smith, MED
• Jennifer E. Smith, M.A., CCC-SLP
• Jennifer Fay Smith, LCPC
• Jennifer Gene Smith, MD
• Jessica Smith
• Jessica Smith, PSYD
• Jessica Lauran Smith
• Jo Anne Smith, MSW LCSW
• John Buchanan Smith III

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; 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.