| NPI | 1043685456 |
|---|---|
| Doing Business As | BLACKMAN GROVE DENTAL |
| Entity Type | Organization |
| Authorized Contact | SHAWN FOSTER Practice Administrator 615-907-4746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2015-12-10 |