Provider Demographics
NPI:1356638472
Name:COSMETIC & FAMILY DENTISTRY
Entity Type:Organization
Organization Name:COSMETIC & FAMILY DENTISTRY
Other - Org Name:NEW IMAGE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BLOURCHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-591-4490
Mailing Address - Street 1:155 COVEY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5602
Mailing Address - Country:US
Mailing Address - Phone:615-591-4490
Mailing Address - Fax:
Practice Address - Street 1:155 COVEY DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5602
Practice Address - Country:US
Practice Address - Phone:615-591-4490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-10
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS53401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932395639OtherPRSONAL NPI
TN3206940Medicaid