Provider Demographics
NPI:1760056402
Name:VINALL & SMITH PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:VINALL & SMITH PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER - PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODDRICK
Authorized Official - Middle Name:SHAMONE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-827-8962
Mailing Address - Street 1:9298 POSITANO LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7393
Mailing Address - Country:US
Mailing Address - Phone:901-827-8962
Mailing Address - Fax:
Practice Address - Street 1:8142 COUNTRY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2053
Practice Address - Country:US
Practice Address - Phone:901-827-8962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531980Medicaid