Elite Dental Care Dyersburg

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ELITE DENTAL CARE DYERSBURG

Doing business as

Elite Dental Care Dyersburg

Practice address

427 Troy Ave
Dyersburg, TN 38024-3947

Phone

(731) 286-1583

NPI assigned

Jul 18, 2022

Last updated

Jul 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tom Lannom

Title

Chief Operating Officer

Phone

(731) 855-1053

Specialties & licenses 1

Addresses

Other names 1

• Elite Dental Care Dyersburg Doing business as

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kate R Avery, DDS

  • Dentist
  • Trenton, TN
  • NPI 1477075281
  NPD (past)
• Molly Edmondson

  • General Practice Dentistry
  • Trenton, TN
  • NPI 1740845734
  NPD (past)
• Mark A Harper, D.D.S.

  • General Practice Dentistry
  • Trenton, TN
  • NPI 1740313154
  NPD (past)
• Randall Paris Prince, DDS

  • General Practice Dentistry
  • Dyersburg, TN
  • NPI 1154464519
  NPD (past)

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

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1801521604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2066 US HIGHWAY 45 BYP S",
            "city": "TRENTON",
            "state": "TN",
            "postal_code": "383823507",
            "telephone_number": "731-855-1053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 TROY AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243947",
            "telephone_number": "731-286-1583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL CARE DYERSBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-18",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "LANNOM",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "731-855-1053"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Dental Care Dyersburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dyersburg Nursing and Rehabilitation LLC
• Dyersburg Practice Management, Inc. (Achieve Medical Weight Loss)
• Dyersburg Radiation Oncology Center, L.L.C. (Cancer Care Center of Dyersburg)
• Dyersburg Surgical Group, Inc.
• Dyersburg Uniform Shoppe
• Elite Healthcare Group P.C. (Pain Relief and Wellness)
• Elite Healthcare Group PC (Pain Relief and Wellness Associates)
• Elite Wound Care LLC
• Jamie L Ellerbrook, APN
• Amy Diane Ellis, COTA/L

• Dental Clinic/Center in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Dental Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.