| NPI | 1194235176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN MICHAEL BIVENS Owner 615-974-2956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 8528) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2017-10-04 |