Provider Demographics
NPI:1003669912
Name:LEWISBURG SMILE STUDIO
Entity Type:Organization
Organization Name:LEWISBURG SMILE STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-418-9021
Mailing Address - Street 1:1508 HIGHWAY 64 W
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-6315
Mailing Address - Country:US
Mailing Address - Phone:615-418-9021
Mailing Address - Fax:
Practice Address - Street 1:302 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2730
Practice Address - Country:US
Practice Address - Phone:931-359-6154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental