| NPI | 1548487531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENELL STUMP Manager Licensing & Credentialing 615-750-0343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2014-07-09 |