NPIMap

Organization Active NPI

Cookeville Regional Dental Associates

  • General Practice Dentistry
  • Cookeville, TN
National Provider Identifier
1972597300
Registry record updated Jan 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COOKEVILLE REGIONAL DENTAL ASSOCIATES
Practice address
327 N Cedar Ave
Cookeville, TN 38501-2420
Phone
(931) 528-5105
Fax
(931) 528-5118
NPI assigned
Aug 31, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2008

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

Authorized official

Name
Regina Ann Johnson, CDA, RDA
Title
Office Manager
Phone
(931) 528-5105

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

327 N Cedar Ave
Cookeville, TN 38501-2420

Mailing address

PO Box 357
Cookeville, TN 38503-0357
Phone (931) 528-5105

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1972597300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 357",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385030357",
            "telephone_number": "931-528-5105",
            "fax_number": "931-528-5118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 N CEDAR AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012420",
            "telephone_number": "931-528-5105",
            "fax_number": "931-528-5118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOKEVILLE REGIONAL DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "REGINA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "931-528-5105",
        "authorized_official_credential": "CDA, RDA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; 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.