Provider Demographics
NPI:1437741014
Name:BRENTWOOD DENTAL ASSOCIATES, PPLC
Entity Type:Organization
Organization Name:BRENTWOOD DENTAL ASSOCIATES, PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-504-5499
Mailing Address - Street 1:4205 HILLSBORO PIKE STE 106
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3339
Mailing Address - Country:US
Mailing Address - Phone:615-730-5566
Mailing Address - Fax:615-386-9032
Practice Address - Street 1:6716 NOLENSVILLE RD STE 120
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8864
Practice Address - Country:US
Practice Address - Phone:157-305-5666
Practice Address - Fax:615-386-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN9433OtherLICENSE