Provider Demographics
NPI:1376966143
Name:WESTHAVEN ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:WESTHAVEN ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-807-2018
Mailing Address - Street 1:7004 MOORES LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2905
Mailing Address - Country:US
Mailing Address - Phone:615-377-7777
Mailing Address - Fax:
Practice Address - Street 1:1025 WESTHAVEN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-4894
Practice Address - Country:US
Practice Address - Phone:615-807-2018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS73611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty