Active NPI
Barry S Pendergrass, DDS
- General Practice Dentistry
- Centerville, TN
National Provider Identifier
1851474779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS6908
- Practice address
- 1824 Ray Morrison Dr
Centerville, TN 37033-3000 - Phone
- (931) 729-3356
- NPI assigned
- Oct 23, 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 | DS6908 | TN | Primary |
Addresses
Primary practice location
1824 Ray Morrison Dr
Centerville, TN 37033-3000
Mailing address
1824 Ray Morrison Dr
Centerville, TN 37033-3000
Phone (931) 729-3356
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DS6908 | Other | TN | DENTAL LIC |
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 |
|---|---|---|---|
| DS6908 | TN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bobby Morrison DDS & Barry Pendergrass DDS, PLLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Centerville, TN
- NPI 1578645024
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851474779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1824 RAY MORRISON DR",
"city": "CENTERVILLE",
"state": "TN",
"postal_code": "370333000",
"telephone_number": "931-729-3356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1824 RAY MORRISON DR",
"city": "CENTERVILLE",
"state": "TN",
"postal_code": "370333000",
"telephone_number": "931-729-3356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDERGRASS",
"first_name": "BARRY",
"middle_name": "S",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TN",
"license": "DS6908",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LIC",
"identifier": "DS6908",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Centerville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.