Provider Demographics
NPI:1205008398
Name:UPPER CUMBERLAND FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:UPPER CUMBERLAND FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:931-823-5517
Mailing Address - Street 1:215 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1726
Mailing Address - Country:US
Mailing Address - Phone:931-823-5517
Mailing Address - Fax:931-823-3852
Practice Address - Street 1:215 OAK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1726
Practice Address - Country:US
Practice Address - Phone:931-823-5517
Practice Address - Fax:931-823-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty