| NPI | 1639386501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMMY J KOEN Owner 615-824-5636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TN 4113) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |