Gloria Maite Serrano Coronado, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

10580 Issued in TN

Practice address

824 W Lamar Alexander Pkwy
Maryville, TN 37801-4578

Phone

(865) 379-7004

Fax

(865) 379-7040

NPI assigned

May 30, 2017

Last updated

Nov 15, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Miss Gloria Maite Coronado Mendez Former name

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blue Ridge Family Dentistry DPC

  • Dentist
  • Maryville, TN
  • NPI 1730462458
  NPD (past)

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

{
    "created_epoch": "1496102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542240000000",
    "number": "1639607195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1537 LECONTE DR",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378035613",
            "telephone_number": "770-364-5648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 W LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378014578",
            "telephone_number": "865-379-7004",
            "fax_number": "865-379-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRANO CORONADO",
        "first_name": "GLORIA",
        "middle_name": "MAITE",
        "name_prefix": "Mrs.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-30",
        "last_updated": "2018-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "10580",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLORIA",
            "last_name": "CORONADO MENDEZ",
            "middle_name": "MAITE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Benjamin James Sentell, DDS
• Kevin James Sentell, MD
• Edwin Senu
• Nicole Marie Seravello, OTR/L
• Clint L Serr, DMD
• Peter Donald Sershon, M.D.
• Ellie Sexton, MSSW
• Shreya Shah
• Ibrahim F Shalaby, MD
• Qurrat Ul Ain Shamim, M.D.

• Dentist in Maryville, TN
• Providers in Maryville, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.