Provider Demographics
NPI:1063665040
Name:PEDIATRIC DENTAL CENTERS, PC
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL CENTERS, PC
Other - Org Name:IN CARE OF STEVE R. LYNN, DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-455-8003
Mailing Address - Street 1:601 NW ATLANTIC ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3536
Mailing Address - Country:US
Mailing Address - Phone:931-455-8003
Mailing Address - Fax:
Practice Address - Street 1:601 NW ATLANTIC ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3536
Practice Address - Country:US
Practice Address - Phone:931-455-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000052011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty