NPIMap

Organization Active NPI

Maple Leaf Implant and General Dentistry, PLLC

  • General Practice Dentistry
  • Cookeville, TN
National Provider Identifier
1679879415
Registry record updated Feb 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7879 Issued in TN
Legal business name
MAPLE LEAF IMPLANT AND GENERAL DENTISTRY, PLLC
Practice address
220 N Washington Ave
Cookeville, TN 38501-2642
Phone
(931) 526-2613
Fax
(931) 646-0901
NPI assigned
Jan 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2016

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

Authorized official

Name
Dr. Jerald A Bryant, DDSNPI 1023026051
Title
Dentist
Phone
(931) 526-2613

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7879 TN Primary

Addresses

Primary practice location

220 N Washington Ave
Cookeville, TN 38501-2642

Mailing address

220 N Washington Ave
Cookeville, TN 38501-2642
Phone (931) 526-2613

Other identifiers 1

IdentifierTypeStateIssuer
Q009025MedicaidTN

National Provider Directory

National Provider Directory

Locations

220 N Washington Ave
Cookeville, TN 38501
Phone (931) 526-2613

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1296000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1679879415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N WASHINGTON AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012642",
            "telephone_number": "931-526-2613",
            "fax_number": "931-646-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N WASHINGTON AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012642",
            "telephone_number": "931-526-2613",
            "fax_number": "931-646-0901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE LEAF IMPLANT AND GENERAL DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-26",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "JERALD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "931-526-2613",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "7879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q009025",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; 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.