NPIMap

Organization Active NPI

Trailhead Pediatric Dentistry

  • Pediatric Dentistry
  • Gallatin, TN
National Provider Identifier
1740851492
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
TRAILHEAD PEDIATRIC DENTISTRY
Practice address
124 Goodview Way Ste B
Gallatin, TN 37066-3125
Phone
(270) 218-0708
NPI assigned
Jul 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Dr. Jonathan David Shadburne, DMDNPI 1861981979
Title
Pediatric Dentist
Phone
(270) 218-0708

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

124 Goodview Way Ste B
Gallatin, TN 37066-3125

Mailing address

809 Dunbar CT
Goodlettsville, TN 37072-1496
Phone (270) 218-0708

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL trailheadpediatricdentistrytn.com Direct

National Provider Directory

National Provider Directory

Locations

124 Goodview Way
Ste B
Gallatin, TN 37066
Phone (270) 218-0708

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": "1625356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1740851492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 DUNBAR CT",
            "city": "GOODLETTSVILLE",
            "state": "TN",
            "postal_code": "370721496",
            "telephone_number": "270-218-0708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 GOODVIEW WAY STE B",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370663125",
            "telephone_number": "270-218-0708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAILHEAD PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-04",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "SHADBURNE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "270-218-0708",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "trailheadpediatricdentistrytn.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "124 Goodview Way Ste B",
            "city": "Gallatin",
            "state": "TN",
            "country_code": "US",
            "postal_code": "370663125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gallatin, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.