Southeastern Dental of Mt Juliet PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SOUTHEASTERN DENTAL OF MT JULIET PLLC

Practice address

631 S Mount Juliet Rd
Mt Juliet, TN 37122-6319

Phone

(615) 754-6677

Fax

(615) 773-5002

NPI assigned

Jun 6, 2019

Organization subpart

No

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

Authorized official

Name

Vickie Metcalf

Title

Practice Administrator

Phone

(615) 568-3258

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559779200000",
    "number": "1568021285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 S MOUNT JULIET RD",
            "city": "MT JULIET",
            "state": "TN",
            "postal_code": "371226319",
            "telephone_number": "615-754-6677",
            "fax_number": "615-773-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 S MOUNT JULIET RD",
            "city": "MT JULIET",
            "state": "TN",
            "postal_code": "371226319",
            "telephone_number": "615-754-6677",
            "fax_number": "615-773-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN DENTAL OF MT JULIET PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-06",
        "last_updated": "2019-06-06",
        "status": "A",
        "authorized_official_last_name": "METCALF",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "615-568-3258"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DARREN FOSTER, DDS",
            "identifier": "1164592226",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R. W. ARCHER",
            "identifier": "1700203007",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KINJAL VORA, DDS",
            "identifier": "1932652302",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wyatt Maclay Smith, PHARMD
• Nicholas John Sobieralski, BCBA
• Allyson E Somers, M.D.
• Michelle Sonnichsen-Kumm
• Michelle Southard
• Southern Home Care Services, Inc.
• Southern Home Care Services, Inc.
• Southern Spine and Sport LLC
• Chelsea M Sparkman, PA-C
• Nicholas Spetko III, M.D

• Dental Clinic/Center in Mt Juliet, TN
• Providers in Mt Juliet, TN by specialty
• Dental Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.

Verify at the official NPI Registry.