Provider Demographics
NPI:1346467073
Name:SOUTHERLAND, JANET H (DDS, MPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:H
Last Name:SOUTHERLAND
Suffix:
Gender:F
Credentials:DDS, MPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 FRANKLIN PIKE APT 507
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2324
Mailing Address - Country:US
Mailing Address - Phone:615-218-6928
Mailing Address - Fax:
Practice Address - Street 1:1005 DR DB TODD JR BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3501
Practice Address - Country:US
Practice Address - Phone:615-327-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59611223G0001X
TN92631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717679Medicaid
90130OtherBCBS
90130OtherBCBS
TN3717679Medicaid