Jack Owen Smalley, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD1918 Issued in NM

Practice address

2650 E Pinon Frontage Rd BLDG 300
Farmington, NM 87402-5084

Phone

(505) 327-3331

Fax

(505) 327-0873

NPI assigned

Apr 26, 2006

Sex

Male

Sole proprietor

Yes

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 and National Provider Directory roles.

• Dr. Jack O. Smalley DSS

  • General Practice Dentistry
  • Farmington, NM
  • NPI 1063989531
  NPD (past)

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541030400000",
    "number": "1487611331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 E PINON FRONTAGE RD BLDG 300",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025084",
            "telephone_number": "505-327-3331",
            "fax_number": "505-327-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 E PINON FRONTAGE RD BLDG 300",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025084",
            "telephone_number": "505-327-3331",
            "fax_number": "505-327-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALLEY",
        "first_name": "JACK",
        "middle_name": "OWEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2018-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD1918",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD1918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84279826",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Farmington, NM
• Providers in Farmington, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2018; 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.