Logan Joe Smith, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12192 Issued in TN

Practice address

208 N Washington St
Tullahoma, TN 37388-3649

Phone

(931) 455-3917

NPI assigned

May 15, 2023

Last updated

May 23, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Glick & Woods Dentistry PLLC

  dba Glick & Woods Dentistry

  • General Practice Dentistry
  • Tullahoma, TN
  • NPI 1689338121
  NPD Authorized official
• DRS. Glick & Woods Dentistry

  • General Practice Dentistry
  • Tullahoma, TN
  • NPI 1962612325
  NPD (past)

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1477244176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 IVY DR",
            "city": "FAYETTEVILLE",
            "state": "TN",
            "postal_code": "373347287",
            "telephone_number": "931-644-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 N WASHINGTON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883649",
            "telephone_number": "931-455-3917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LOGAN",
        "middle_name": "JOE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "12192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Skills Development Services, Inc.
• Lindsay Dawn Skipper
• Jennifer Leigh Slater, NP
• Amy Elizabeth Smith, PHARMD
• J Randall Smith, D.D.S.,M.S.
• Megan Smith, FNP-BC
• Stacey Michelle Smith
• Adam Snider
• Ashlan Charlotte Snyder
• Heather R Sohrabi, OD

• Dentist in Tullahoma, TN
• Providers in Tullahoma, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; 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.