NPIMap

Organization Active NPI

Dental Spa PLLC

  • Dentist
  • Smyrna, TN
National Provider Identifier
1790189249
Registry record updated Oct 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8012 Issued in TN
Legal business name
DENTAL SPA PLLC
Practice address
125 Enon Springs Rd E
Smyrna, TN 37167-3032
Phone
(615) 459-2579
NPI assigned
Oct 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2014

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

Authorized official

Name
Dr. Tracie Battle, D.M.D.
Title
Dentist
Phone
(615) 459-2579

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 8012 TN Primary

Addresses

Primary practice location

125 Enon Springs Rd E
Smyrna, TN 37167-3032

Mailing address

PO Box 2623
Brentwood, TN 37024-2623

Other identifiers 1

IdentifierTypeStateIssuer
12454814MedicaidTN

National Provider Directory

National Provider Directory

Locations

125 Enon Springs Rd E
Smyrna, TN 37167
Phone (615) 459-2579

NPI Registry JSON

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

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1790189249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2623",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370242623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 ENON SPRINGS RD E",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371673032",
            "telephone_number": "615-459-2579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SPA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-13",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "BATTLE",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "615-459-2579",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "8012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12454814",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smyrna, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; 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.