Provider Demographics
NPI:1053818666
Name:HERITAGE FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:HERITAGE FAMILY DENTAL, PLLC
Other - Org Name:FAMILY DENTAL CARE OF MURFREESBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-849-3522
Mailing Address - Street 1:3138 S CHURCH ST STE H
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-7263
Mailing Address - Country:US
Mailing Address - Phone:615-849-3522
Mailing Address - Fax:
Practice Address - Street 1:3138 S CHURCH ST STE H
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-7263
Practice Address - Country:US
Practice Address - Phone:615-849-3522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE FAMILY DENTAL, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-10
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty