| NPI | 1568473759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENELL STUMP Manager, Licensing Credentialing 615-750-0343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2014-07-09 |