| NPI | 1568533727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENELL STUMP Manager, Licensing & Credentialing 615-750-0343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2014-07-09 |