Provider Demographics
NPI:1427222108
Name:FAMILY DENTAL ASSOCIATES AT CAMPBELL STATION, PC
Entity Type:Organization
Organization Name:FAMILY DENTAL ASSOCIATES AT CAMPBELL STATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-302-1414
Mailing Address - Street 1:2206 SPEDALE CT
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6137
Mailing Address - Country:US
Mailing Address - Phone:615-302-1414
Mailing Address - Fax:615-302-1434
Practice Address - Street 1:2206 SPEDALE CT
Practice Address - Street 2:SUITE 6
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6137
Practice Address - Country:US
Practice Address - Phone:615-302-1414
Practice Address - Fax:615-302-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty