NPIMap

Organization Active NPI

Rainsville Pediatric Dental Village

  • Pediatric Dentistry
  • Rainsville, AL
National Provider Identifier
1871976399
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
5126 Issued in AL
Legal business name
RAINSVILLE PEDIATRIC DENTAL VILLAGE
Practice address
371 McCurdy Ave S
Rainsville, AL 35986-5215
Phone
(256) 638-3000
Fax
(256) 638-3099
NPI assigned
Jul 1, 2015
Last updated
Jul 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Authorized official

Name
Dr. Tara L Moncus, DMDNPI 1003811241
Title
Dentsit/Owner
Phone
(256) 638-3000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6198 AL
Pediatric Dentistry 1223P0221X 5126 AL Primary

Addresses

Primary practice location

371 McCurdy Ave S
Rainsville, AL 35986-5215

Mailing address

371 McCurdy Ave S
Rainsville, AL 35986-5215
Phone (256) 638-3000

Other identifiers 1

IdentifierTypeStateIssuer
1003811241MedicaidAL

National Provider Directory

National Provider Directory

Locations

371 McCurdy Ave S
Rainsville, AL 35986
Phone (256) 638-3000

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1871976399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 MCCURDY AVE S",
            "city": "RAINSVILLE",
            "state": "AL",
            "postal_code": "359865215",
            "telephone_number": "256-638-3000",
            "fax_number": "256-638-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 MCCURDY AVE S",
            "city": "RAINSVILLE",
            "state": "AL",
            "postal_code": "359865215",
            "telephone_number": "256-638-3000",
            "fax_number": "256-638-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAINSVILLE PEDIATRIC DENTAL VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "MONCUS",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTSIT/OWNER",
        "authorized_official_telephone_number": "256-638-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "6198",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AL",
            "license": "5126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003811241",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rainsville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.

Verify at the official NPI Registry.