| NPI | 1942745963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA WILBURN SOUTHWELL Dentist 615-822-2214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 8834) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2017-02-06 |