Provider Demographics
NPI:1194393033
Name:REM DDS LLC
Entity Type:Organization
Organization Name:REM DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:RIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-505-6843
Mailing Address - Street 1:15576 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15576 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-7330
Practice Address - Country:US
Practice Address - Phone:402-505-6843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REM DDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental