Active NPI
Jacob Shea, DMD
- Dentist
- Knoxville, TN
National Provider Identifier
1467010314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11032
- Practice address
- 2964 Miller Place Way
Knoxville, TN 37924-1673 - Phone
- (865) 770-4477
- NPI assigned
- Jun 4, 2019
- Last updated
- Jun 4, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11032 | TN | Primary |
Addresses
Primary practice location
2964 Miller Place Way
Knoxville, TN 37924-1673
Mailing address
8124 Cambridge Reserve Dr
Knoxville, TN 37924-5515
Phone (702) 271-5506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11032 | TN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559606400000",
"number": "1467010314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8124 CAMBRIDGE RESERVE DR",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379245515",
"telephone_number": "702-271-5506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2964 MILLER PLACE WAY",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379241673",
"telephone_number": "865-770-4477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEA",
"first_name": "JACOB",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-04",
"last_updated": "2019-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "11032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.