| NPI | 1003468422 |
|---|---|
| Doing Business As | [email protected] |
| Entity Type | Organization |
| Authorized Contact | DRAKE DUDLEY General Dentist 615-678-8965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2019-07-16 |