Provider Demographics
NPI:1306026331
Name:HEARTLAND DENTAL CARE OF TENNESSEE, PC
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF TENNESSEE, PC
Other - Org Name:CROSSROADS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:4515 HARDING RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2118
Mailing Address - Country:US
Mailing Address - Phone:615-385-2005
Mailing Address - Fax:615-460-9611
Practice Address - Street 1:4515 HARDING RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2118
Practice Address - Country:US
Practice Address - Phone:615-385-2005
Practice Address - Fax:615-460-9611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF TENNESSEE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty