NPIMap

Organization Active NPI

CD Tennessee Dental, P.C.

Doing business as Brentwood Dental Group

  • Dentist
  • Brentwood, TN
National Provider Identifier
1962978742
Registry record updated May 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CD TENNESSEE DENTAL, P.C.
Doing business as
Brentwood Dental Group
Practice address
8112 Isabella LN Ste 101
Brentwood, TN 37027-9102
Phone
(615) 778-0810
Fax
(615) 277-0808
NPI assigned
Oct 18, 2018
Last updated
May 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2023

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

Authorized official

Name
Ty Justice
Title
Director, Payer Relations
Phone
(513) 609-4076

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary
General Practice Dentistry 1223G0001X NU

Addresses

Primary practice location

8112 Isabella LN Ste 101
Brentwood, TN 37027-9102

Mailing address

9825 Kenwood Rd Ste 200
Blue Ash, OH 45242-6252
Phone (513) 609-4115

Other names 1

  • Brentwood Dental Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CD Tennessee Dental PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8112 Isabella Ln
Ste 101
Brentwood, TN 37027
Phone (615) 778-0810

Practitioners & affiliated clinicians

Practitioners 3

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": "1539820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1962978742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9825 KENWOOD RD STE 200",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426252",
            "telephone_number": "513-609-4115",
            "fax_number": "513-448-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8112 ISABELLA LN STE 101",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370279102",
            "telephone_number": "615-778-0810",
            "fax_number": "615-277-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CD TENNESSEE DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-18",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "TY",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "513-609-4076"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brentwood Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brentwood Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brentwood, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; 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.