| NPI | 1043388713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOAN DEWALD Practice Administrator 931-572-9175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 3417) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 6850) |
| 1223G0001X Dentist General Practice (Licence: TN 1542) | |
| 1223G0001X Dentist General Practice (Licence: TN 8301) | |
| 1223G0001X Dentist General Practice (Licence: TN 8580) | |
| 1223G0001X Dentist General Practice (Licence: TN 8275) | |
| 1223G0001X Dentist General Practice (Licence: TN 8596) | |
| 1223G0001X Dentist General Practice (Licence: TN 8290) | |
| 1223G0001X Dentist General Practice (Licence: TN 8317) | |
| 1223G0001X Dentist General Practice (Licence: TN 8259) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-08-22 |