Provider Demographics
NPI:1407000417
Name:DARRYL T DEASON
Entity Type:Organization
Organization Name:DARRYL T DEASON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-563-2266
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1047
Mailing Address - Country:US
Mailing Address - Phone:615-563-2266
Mailing Address - Fax:615-563-4258
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1047
Practice Address - Country:US
Practice Address - Phone:615-563-2266
Practice Address - Fax:615-563-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS35751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty