Provider Demographics
NPI:1225425069
Name:MID TN DENTISTRY EAST SMYRNA LLC
Entity Type:Organization
Organization Name:MID TN DENTISTRY EAST SMYRNA LLC
Other - Org Name:MID TN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-310-0022
Mailing Address - Street 1:405 WILD ELM ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-8650
Mailing Address - Country:US
Mailing Address - Phone:615-310-0022
Mailing Address - Fax:
Practice Address - Street 1:431 NISSAN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4364
Practice Address - Country:US
Practice Address - Phone:615-459-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN7885261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental