Individual provider Active NPI

William Kyle McShan, D.D.S

  • Dentist
  • Crossville, TN
National Provider Identifier
1790097384
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9285 Issued in TN
Practice address
1357 Interstate Dr
Crossville, TN 38555-6184
Phone
(931) 337-4447
Fax
(931) 787-1257
NPI assigned
Jul 12, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 9285 TN Primary

Addresses

Primary practice location

1357 Interstate Dr
Crossville, TN 38555-6184

Mailing address

1357 Interstate Dr
Crossville, TN 38555-6184
Phone (931) 787-1277

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151216002077 TN Order and Referring Only - Other (Non-Physician) 8729389721

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9285TNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Dental Family and Implant Dentistry Single Specialty Current Accepting new patients
Plateau Family Dentistry Dentist CurrentSince Oct 5, 2025 Accepting new patients

Locations

1357 Interstate Dr
Crossville, TN 38555
Phone (931) 337-4447

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1790097384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1357 INTERSTATE DR",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385556184",
            "telephone_number": "931-787-1277",
            "fax_number": "931-787-1257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 INTERSTATE DR",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385556184",
            "telephone_number": "931-337-4447",
            "fax_number": "931-787-1257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCSHAN",
        "first_name": "WILLIAM",
        "middle_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-12",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "9285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crossville, TN

Sources for this page

Verify at the official NPI Registry.