Individual provider Active NPI

Nadareh M Naseri, D.D.S.

  • Pediatric Dentistry
  • Knoxville, TN
National Provider Identifier
1629565494
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
11896 Issued in TN
Practice address
1516 Coleman Rd Ste 201
Knoxville, TN 37909-3809
Phone
(865) 558-8857
NPI assigned
Apr 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 11896 TN Primary

Addresses

Primary practice location

1516 Coleman Rd Ste 201
Knoxville, TN 37909-3809

Mailing address

1516 Coleman Rd Ste 201
Knoxville, TN 37909-3809
Phone (865) 558-8857

Other practice location 1

209 E Emory Rd Ste 101
Powell, TN 37849-4050
Phone (865) 512-9611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11896TNMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Dentistry PC Pediatric Dentistry PastSince Jan 14, 2024 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1629565494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 COLEMAN RD STE 201",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379093809",
            "telephone_number": "865-558-8857",
            "fax_number": "865-321-8376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 COLEMAN RD STE 201",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379093809",
            "telephone_number": "865-558-8857"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "209 E Emory Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Powell",
            "state": "TN",
            "postal_code": "378494050",
            "country_code": "US",
            "telephone_number": "865-512-9611",
            "fax_number": "865-321-8376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NASERI",
        "first_name": "NADAREH",
        "middle_name": "M",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-17",
        "last_updated": "2024-01-10",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "11896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; 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.