| NPI | 1518299676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DAWN AVELLO Front Office Manager 615-790-4994 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 7885) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 8268) |
| 122300000X Dentist (Licence: TN 9003) | |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2010-02-01 |