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ETHELYN JEAN PAK
NPI 1083168538
Dentist in Smyrna, TN

Active since August 12, 2016PECOS Enrolled
440 SAM RIDLEY PKWY W, SMYRNA, TN 37167(615) 625-2955 Get Directions Write a Review

NPPES record last updated: August 17, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 17, 2016, Aug 12, 2016 (2 updates tracked since 2016).

About Ethelyn Jean Pak NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHELYN JEAN PAK (NPI 1083168538) is an individual dentist in Smyrna, Tennessee, licensed in Tennessee (10295) and active in the NPI registry since August 2016. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1083168538
Entity TypeIndividualFemale
Primary Taxonomy122300000X
Provider Legal NameETHELYN JEAN PAK
Location Address440 SAM RIDLEY PKWY WSmyrna, TN 37167-2998
Mailing Address1518 Red Oak Dr.Brentwood, TN 37027 · (615) 483-0728
Phone(615) 625-2955
Sole ProprietorYes
Enumeration DateAugust 12, 2016
Last NPPES UpdateAugust 17, 20162 updates tracked since enumeration
✔ NPI 1083168538 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in TN · 10295
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
440 SAM RIDLEY PKWY W, Smyrna, TN 37167
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ethelyn Jean Pak is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37167 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.53 typical visit price
range $52.64 – $160.89
Typical copayment $20.38 (range $13.16 – $40.22)
Most-billed visit code 99203
Established Patient
$66.01 typical visit price
range $16.72 – $131.41
Typical copayment $16.50 (range $4.18 – $32.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YEWANDE O. OYE-SOMEFUN DDS
Dentist (General Practice)
440 SAM RIDLEY PKWY W
SMYRNA, TN 37167
Rutherford County (615) 930-9606
CECILY M WILLIAMS DDS, PC
Dentist (General Practice)
440 SAM RIDLEY PKWY W
SMYRNA, TN 37167
Rutherford County (315) 454-6000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethelyn Pak's NPI number?

The NPI number for Ethelyn Pak is 1083168538. It was assigned to this individual provider in the NPPES registry on August 12, 2016.

Where is Ethelyn Pak located?

Ethelyn Pak practices at 440 Sam Ridley Pkwy W, Smyrna, TN 37167. The listed phone number is (615) 625-2955.

What is Ethelyn Pak's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Ethelyn Pak enrolled in Medicare?

Yes. Ethelyn Pak is registered in the Medicare PECOS enrollment system.

What insurance does Ethelyn Pak accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 9 other insurers list Ethelyn Pak as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ethelyn Pak was last updated on August 17, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.