NPIMap

Organization Active NPI

Crystal Clear Family Dentistry

  • Dentist
  • Smyrna, TN
National Provider Identifier
1659156719
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CRYSTAL CLEAR FAMILY DENTISTRY
Doing business as
Crystal Clear Family Dentistry
Practice address
1210 Hazelwood Dr Ste a
Smyrna, TN 37167-3964
Phone
(615) 930-2050
Fax
(615) 459-0568
NPI assigned
Aug 28, 2023
Last updated
Aug 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Authorized official

Name
Dr. Sarah Mekonnen, DDSNPI 1578899837
Title
Ceo/Owner
Phone
(615) 584-3861

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

1210 Hazelwood Dr Ste a
Smyrna, TN 37167-3964

Mailing address

415 Avondale Dr
Nashville, TN 37206-1818
Phone (615) 584-3861

Other identifiers 1

IdentifierTypeStateIssuer
1437897907MedicaidTN

Other names 1

  • Crystal Clear Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1210 Hazelwood Dr
Ste A
Smyrna, TN 37167
Phone (615) 459-0566

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1693180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1659156719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 AVONDALE DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372061818",
            "telephone_number": "615-584-3861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 HAZELWOOD DR STE A",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371673964",
            "telephone_number": "615-930-2050",
            "fax_number": "615-459-0568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CLEAR FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "MEKONNEN",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "615-584-3861",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437897907",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Clear Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Smyrna, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.