Jackie L Smith, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2007034336 Issued in MO

Practice address

154 Welford LN
Branson, MO 65616-3418

Phone

(417) 332-2980

NPI assigned

Oct 13, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1286928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286928000000",
    "number": "1609186576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 WELFORD LN",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656163418",
            "telephone_number": "417-332-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 WELFORD LN",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656163418",
            "telephone_number": "417-332-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACKIE",
        "middle_name": "L",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-13",
        "last_updated": "2010-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2007034336",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "1991",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "1935",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Skaggs Community Hosptial Association
• Skaggs-Cox Health Alliance, LLC.
• Katherine Dollie Skaggs, D.O.
• Smith Management Services, LLC
• Smith Management Services, LLC
• Jeffrey Smith
• Keith Delbert Smith, DPT
• Mandolin Smith, PA-C
• Templeton Smith III, M.D.
• SNH Al Aimo Tenant, Inc.

• Dentist in Branson, MO
• Providers in Branson, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; 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.