Dothan Smiles Youth Dentistry, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DOTHAN SMILES YOUTH DENTISTRY, PC

Practice address

5412 Montgomery Hwy
Suite 8
Dothan, AL 36303-1657

Phone

(334) 983-1730

Fax

(334) 983-1725

NPI assigned

Apr 19, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Jenell Stump

Title

Manager - Licensing & Credentialing

Phone

(615) 750-0343

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1548487531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ARCADE UNIT 198747",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372191994",
            "telephone_number": "615-750-0343",
            "fax_number": "615-986-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 MONTGOMERY HWY",
            "address_2": "SUITE 8",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031657",
            "telephone_number": "334-983-1730",
            "fax_number": "334-983-1725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOTHAN SMILES YOUTH DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "MANAGER - LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "615-750-0343",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529932450",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dothan Primary Care LLC
• Dothan Professional Counseling Services
• Dothan Psychiatric, PC
• Dothan Psychiatry & Sleep Disorders Medicine, PC
• Dothan RX LLC
• Dothan Spine & Specialty LLC
• Dothan Surgery Center, LLC
• Dothan Surgical Services, LLC
• Dothan Therapy Associates Inc
• Dothan Urology, PC

• General Practice Dentistry in Dothan, AL
• Providers in Dothan, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.