Individual provider Active NPI

Don E. Smith Sr., DDS

  • General Practice Dentistry
  • Kosciusko, MS
National Provider Identifier
1457402299
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1253-66 Issued in MS
Practice address
300 W Adams St
Kosciusko, MS 39090-3644
Phone
(662) 289-2570
Fax
(662) 289-2580
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1253-66 MS Primary

Addresses

Primary practice location

300 W Adams St
Kosciusko, MS 39090-3644

Mailing address

300 W Adams St
P O Box 627
Kosciusko, MS 39090-3644
Phone (662) 289-2570

Other identifiers 1

IdentifierTypeStateIssuer
00062490MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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

Enrollment IDStateProvider typePAC IDDetails
I20231206001358 MS Order and Referring Only - DentistPractitioner - Dentist 3577852961

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1457402299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W ADAMS ST",
            "address_2": "P O BOX 627",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903644",
            "telephone_number": "662-289-2570",
            "fax_number": "662-289-2580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W ADAMS ST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903644",
            "telephone_number": "662-289-2570",
            "fax_number": "662-289-2580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DON",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "1253-66",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00062490",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kosciusko, MS

Sources for this page

Verify at the official NPI Registry.