Provider Demographics
NPI:1396032777
Name:PERFECT SMILES DENTAL CENTER
Entity Type:Organization
Organization Name:PERFECT SMILES DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIYE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-459-0566
Mailing Address - Street 1:1210 HAZELWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3964
Mailing Address - Country:US
Mailing Address - Phone:615-459-0566
Mailing Address - Fax:615-459-0568
Practice Address - Street 1:1210 HAZELWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3964
Practice Address - Country:US
Practice Address - Phone:615-459-0566
Practice Address - Fax:615-459-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8170TN305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5442227Medicaid