Marissa Sandidge, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

10377 Issued in TN

Practice address

1100 Neal St Ste B
Cookeville, TN 38501-0900

Phone

(931) 240-6224

NPI assigned

Jan 12, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Marissa Ludley Former name

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.

• East Nashville Pediatric Dentistry, PLLC

  • Pediatric Dentistry
  • Nashville, TN
  • NPI 1326685132
  NPD Authorized official

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

{
    "created_epoch": "1421020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546300800000",
    "number": "1992194195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 MCEWEN AVE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372061856",
            "telephone_number": "770-633-6566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 NEAL ST STE B",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385010900",
            "telephone_number": "931-240-6224"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 Bonnabrook Dr",
            "address_purpose": "LOCATION",
            "city": "Hermitage",
            "state": "TN",
            "postal_code": "370761910",
            "country_code": "US",
            "telephone_number": "615-205-5956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDIDGE",
        "first_name": "MARISSA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-12",
        "last_updated": "2019-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021436",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "10377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q026169",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "LUDLEY",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sam's East, Inc (Sam's Club Vision Center 30-4930)
• Norman Sampley, LPN
• Sams East Inc (Sams Pharmacy 10-4930)
• Brian Samuel, MD
• Pamela J Sanders, M.D.
• Evan Sanford, M.D.
• Kimberly Sanford
• Sarah Morgan Counseling & Consulting PLLC (Sarah Morgan MA LPC-MHSP)
• Robert Sarfo, PHD, PMHNP-BC, RN
• Kayla Garrison Sarji, PT,DPT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2019; 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.