Provider Demographics
NPI:1003078486
Name:EBLE, MICHEAL TATE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:TATE
Last Name:EBLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HOLIDAY CT
Mailing Address - Street 2:SUITE 117
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-3061
Mailing Address - Country:US
Mailing Address - Phone:615-794-8977
Mailing Address - Fax:615-794-8945
Practice Address - Street 1:128 HOLIDAY CT
Practice Address - Street 2:SUITE 117
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-3061
Practice Address - Country:US
Practice Address - Phone:615-794-8977
Practice Address - Fax:615-794-8945
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN88621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice