Crystal Gilreath Rucker, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

8466 Issued in TN

Practice address

2622 Madison St Ste G
Clarksville, TN 37043-6555

Phone

(931) 919-4898

Fax

(931) 919-4897

NPI assigned

Dec 5, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Sango Smiles Pediatric Dentistry

  • Pediatric Dentistry
  • Clarksville, TN
  • NPI 1538679097
  NPD (past) Authorized official

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509321600000",
    "number": "1962560631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7520 LORDS CHAPEL DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372117040",
            "telephone_number": "615-557-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2622 MADISON ST STE G",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370436555",
            "telephone_number": "931-919-4898",
            "fax_number": "931-919-4897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKER",
        "first_name": "CRYSTAL",
        "middle_name": "GILREATH",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2017-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "DS8466",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "8466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Renee Rousseau, D.C.
• Steven B Routledge, O.D.
• Zuhkera Rowe
• Tashala Simpson Royster, M. S., CCC-SLP
• RRWC, PLLC
• Mykalah Rudd, RN
• Monserrath Katherine Rudisill
• Jeffrey Battle Rudolph
• Melody Ruiz, CSW
• Running Springs Healthcare

• Pediatric Dentistry in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Pediatric Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; 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.