Provider Demographics
NPI:1255846234
Name:ORTHODONTISTS OF MIDDLE TN GENERAL PARTNERSHIP
Entity Type:Organization
Organization Name:ORTHODONTISTS OF MIDDLE TN GENERAL PARTNERSHIP
Other - Org Name:ABOUT FACES AND BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHMAN-GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:615-384-2484
Mailing Address - Street 1:3130 TOM AUSTIN HWY STE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-4579
Mailing Address - Country:US
Mailing Address - Phone:615-384-2484
Mailing Address - Fax:615-384-9555
Practice Address - Street 1:324 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3963
Practice Address - Country:US
Practice Address - Phone:615-384-2484
Practice Address - Fax:615-384-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND79881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025420Medicaid
TNQ025420Medicaid