Provider Demographics
NPI:1417023599
Name:CASTLE MID-SOUTH DENTAL CENTERS
Entity Type:Organization
Organization Name:CASTLE MID-SOUTH DENTAL CENTERS
Other - Org Name:CASTLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-794-0402
Mailing Address - Street 1:1010 MURFREESBORO RD
Mailing Address - Street 2:SUITE 196
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3000
Mailing Address - Country:US
Mailing Address - Phone:615-794-0402
Mailing Address - Fax:
Practice Address - Street 1:1010 MURFREESBORO RD
Practice Address - Street 2:SUITE 196
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3000
Practice Address - Country:US
Practice Address - Phone:615-794-0402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty