Bethany Sue Small – General Practice Dentistry

Key facts

NPI: 1407928682
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 20747 (OH)
Practice address: 424 Avon Belden Rd
Avon Lake, OH 44012-2295
Phone: (440) 930-5233
Fax: (440) 930-5234
NPI assigned: Nov 14, 2006
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
20747	OH	MD	General Practice Dentistry

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	20747	OH	Yes

Addresses

Primary practice location

424 Avon Belden Rd
Avon Lake, OH 44012-2295

Mailing address

424 Avon Belden Rd
Avon Lake, OH 44012-2295
Phone (440) 930-5233

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 25, 2009.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245888000000",
    "number": "1407928682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 AVON BELDEN RD",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "440122295",
            "telephone_number": "440-930-5233",
            "fax_number": "440-930-5234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 AVON BELDEN RD",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "440122295",
            "telephone_number": "440-930-5233",
            "fax_number": "440-930-5234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALL",
        "first_name": "BETHANY",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2009-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "20747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon Lake, OH

All providers in Avon Lake, OH · General Practice Dentistry in Ohio

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2009. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.