| NPI | 1417312562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES KELLUM Dentist 615-604-5584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN 8995) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2015-12-16 |