| NPI | 1508292269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY DIANE BUSH Doctor's Wife 615-401-1103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS3134) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2013-09-25 |