Provider Demographics
NPI:1346474541
Name:TULLAHOMA DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:TULLAHOMA DENTAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SCALLIONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-454-0001
Mailing Address - Street 1:1958 N. JACKSON ST.
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-454-0001
Mailing Address - Fax:931-454-0973
Practice Address - Street 1:1958 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2204
Practice Address - Country:US
Practice Address - Phone:931-454-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4464122300000X
TN7889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty