| NPI | 1609532126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH NEIL SULLIVAN Director Rcm 615-601-5250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2021-11-09 |