Provider Demographics
NPI:1275082745
Name:KAIL, GROBMYER & LEONARD DENISTRY
Entity Type:Organization
Organization Name:KAIL, GROBMYER & LEONARD DENISTRY
Other - Org Name:PREMIER DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-613-2800
Mailing Address - Street 1:14029 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-6195
Mailing Address - Country:US
Mailing Address - Phone:731-613-2800
Mailing Address - Fax:731-613-2803
Practice Address - Street 1:14029 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-6195
Practice Address - Country:US
Practice Address - Phone:731-613-2800
Practice Address - Fax:731-613-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS7790122300000X
TNDS10347122300000X
TNDS8401122300000X
TNDS3413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty