Active NPI
Nathan Randall Smith, D.M.D.
- General Practice Dentistry
- Birmingham, AL
National Provider Identifier
1750462214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5436
- Practice address
- 3220 5TH Ave S # Dew2002
Birmingham, AL 35222-2309 - Phone
- (205) 975-9842
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5436 | AL | Primary |
Addresses
Primary practice location
3220 5TH Ave S # Dew2002
Birmingham, AL 35222-2309
Mailing address
3220 5TH Ave S #Dew2002
Birmingham, AL 35222-2309
Phone (205) 975-9842
Other practice location 1
1520 Cooper Hill Rd
Irondale, AL 35210-2303
Phone (205) 731-3115
Other practice location 2
1424 Montclair Rd
Irondale, AL 35210-2208
Phone (205) 951-1473
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 107861 | Medicaid | AL | |
| 123847 | Medicaid | AL | |
| 510-48371 | Other | AL | BLUE CROSS BLUE SHIELD WESTERN DENTAL |
| 009910280 | Medicaid | AL | |
| 515-41700 | Other | AL | BLUE CROSS BLUE SHIELD EASTERN DENTAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5436 | AL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729036800000",
"number": "1750462214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3220 5TH AVE S #DEW2002",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352222309",
"telephone_number": "205-975-9842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3220 5TH AVE S # DEW2002",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352222309",
"telephone_number": "205-975-9842"
}
],
"practiceLocations": [
{
"address_1": "1520 Cooper Hill Rd",
"address_purpose": "LOCATION",
"city": "Irondale",
"state": "AL",
"postal_code": "352102303",
"country_code": "US",
"telephone_number": "205-731-3115",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1424 Montclair Rd",
"address_purpose": "LOCATION",
"city": "Irondale",
"state": "AL",
"postal_code": "352102208",
"country_code": "US",
"telephone_number": "205-951-1473",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "NATHAN",
"middle_name": "RANDALL",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2024-10-16",
"certification_date": "2024-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AL",
"license": "5436",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "107861",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "123847",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD WESTERN DENTAL",
"identifier": "510-48371",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009910280",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD EASTERN DENTAL",
"identifier": "515-41700",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.