Provider Demographics
NPI:1114222437
Name:CENTER FOR ANTI-AGING MEDICINE & DENTISTRY, INC.
Entity Type:Organization
Organization Name:CENTER FOR ANTI-AGING MEDICINE & DENTISTRY, INC.
Other - Org Name:YOUR DOCTORS4LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-472-1795
Mailing Address - Street 1:3351 ASPEN GROVE DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2909
Mailing Address - Country:US
Mailing Address - Phone:615-472-1795
Mailing Address - Fax:615-472-1797
Practice Address - Street 1:3351 ASPEN GROVE DR
Practice Address - Street 2:SUITE 350
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2909
Practice Address - Country:US
Practice Address - Phone:615-472-1795
Practice Address - Fax:615-472-1797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty