| NPI | 1265620082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENELL STUMP Manager, Licensing & Credentialing 615-750-0343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2014-07-09 |