Provider Demographics
NPI:1467184952
Name:HEARTLAND DENTAL CARE OF TENNESSEE, PC
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF TENNESSEE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:1008 GANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2060
Mailing Address - Country:US
Mailing Address - Phone:629-529-4041
Mailing Address - Fax:629-529-4233
Practice Address - Street 1:1008 GANT HILL DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2060
Practice Address - Country:US
Practice Address - Phone:629-529-4041
Practice Address - Fax:629-529-4233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF TENNESSEE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty