Smith, J Randall

Smith, J Randall is an individual health care provider with primary practice located at 205 S Jackson St , Tullahoma TN 37388-4426. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Smith, J Randall can be contacted via phone (931) 455-0146.

Contact Information

Primary practice address
205 S Jackson St Tullahoma TN 37388-4426
Phone: (931) 455-0146
Fax: (931) 393-3863
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X 179 Tennessee

Profile Details

NPI number 1114917010
LBN Legal business name Smith, J Randall
Credentials D.D.S.,M.S.
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114917010 NPPES
Other 844210 UNITED CONCORDIA
Other 0160873 UNITED CONCORDIA
Other 0006684 UNITED CONCORDIA

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