MEDICARE: WHITE OAK DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1457066565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE OAK DENTAL

Provider Business Mailing Address
First Line	:	214 N MAIN ST
Second Line	:
City	:	JAMESTOWN
State	:	TN
Zip	:	38556-3748
Country	:	US
Telephone Number	:	931-879-5834
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 CENTRAL AVE W
Second Line	:
City	:	JAMESTOWN
State	:	TN
Zip	:	38556-3557
Country	:	US
Telephone Number	:	931-879-9544
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. BRANDON SMITH
Credential	:	DDS
Telephone Number	:	931-879-5834

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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