Healthcare Provider Details

I. General information

NPI: 1760056402
Provider Name (Legal Business Name): VINALL & SMITH PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8142 COUNTRY VILLAGE DR
CORDOVA TN
38016-2053
US

IV. Provider business mailing address

9298 POSITANO LN
GERMANTOWN TN
38138-7393
US

V. Phone/Fax

Practice location:
  • Phone: 901-827-8962
  • Fax:
Mailing address:
  • Phone: 901-827-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1531980
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: DR. TODDRICK SHAMONE SMITH
Title or Position: PARTNER - PEDIATRIC DENTIST
Credential: DDS
Phone: 901-827-8962