Provider Demographics
NPI:1083174080
Name:ASHLAND CITY DENTAL, P.C.
Entity Type:Organization
Organization Name:ASHLAND CITY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:FLEENOR
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-235-5144
Mailing Address - Street 1:189 MONROE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-4940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:189 MONROE PL STE 104
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-4940
Practice Address - Country:US
Practice Address - Phone:706-442-1469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental