NPIMap

Organization Active NPI

CD Tennessee Dental, P.C.

  • General Practice Dentistry
  • Chattanooga, TN
National Provider Identifier
1740797208
Registry record updated May 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CD TENNESSEE DENTAL, P.C.
Practice address
6102 Shallowford Rd Ste 101
Chattanooga, TN 37421-1684
Phone
(423) 499-9300
Fax
(423) 499-9746
NPI assigned
Jan 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2023

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

Authorized official

Name
Ty V. Justice
Title
Director, Credentialing
Phone
(513) 609-4076

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

6102 Shallowford Rd Ste 101
Chattanooga, TN 37421-1684

Mailing address

9825 Kenwood Rd Ste 200
Blue Ash, OH 45242-6252
Phone (513) 609-4076

Other names 1

  • Chattanooga Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CD Tennessee Dental PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1515110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1740797208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9825 KENWOOD RD STE 200",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426252",
            "telephone_number": "513-609-4076",
            "fax_number": "513-448-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6102 SHALLOWFORD RD STE 101",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374211684",
            "telephone_number": "423-499-9300",
            "fax_number": "423-499-9746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CD TENNESSEE DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-05",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "TY",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING",
        "authorized_official_telephone_number": "513-609-4076"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chattanooga Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.