Active NPI
Cordell W Tolliver, DMD
- Dentist
- Middlesboro, KY
National Provider Identifier
1841395829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4989
- Practice address
- 714 Exeter Avenue
Middlesboro, KY 40965-1461 - Phone
- (606) 248-5302
- Fax
- (606) 248-5302
- NPI assigned
- Sep 14, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4989 | KY | Primary |
Addresses
Primary practice location
714 Exeter Avenue
Middlesboro, KY 40965-1461
Mailing address
714 Exeter Avenue
Middlesboro, KY 40965-1461
Phone (606) 248-5302
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0160739 | Other | TN | BCBS TENN |
| 0688009 | Other | VA | DELTA DENTAL |
| 60049897 | Medicaid | KY |
Other names 1
- Cordell W Tolliver
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 |
|---|---|---|---|
| 4989 | KY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450396800000",
"number": "1841395829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 EXETER AVENUE",
"city": "MIDDLESBORO",
"state": "KY",
"postal_code": "409651461",
"telephone_number": "606-248-5302",
"fax_number": "606-248-5302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 EXETER AVENUE",
"city": "MIDDLESBORO",
"state": "KY",
"postal_code": "409651461",
"telephone_number": "606-248-5302",
"fax_number": "606-248-5302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOLLIVER",
"first_name": "CORDELL",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2015-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "4989",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS TENN",
"identifier": "0160739",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL",
"identifier": "0688009",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60049897",
"state": "KY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CORDELL",
"last_name": "TOLLIVER",
"middle_name": "W",
"credential": "DMD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Middlesboro, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.