Provider Demographics
NPI:1467621235
Name:WHITE BLUFF DENTAL
Entity Type:Organization
Organization Name:WHITE BLUFF DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:N
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:615-797-5877
Mailing Address - Street 1:4335 HWY 70 E
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-9234
Mailing Address - Country:US
Mailing Address - Phone:615-797-5877
Mailing Address - Fax:615-797-5880
Practice Address - Street 1:4335 HWY 70 E
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-9234
Practice Address - Country:US
Practice Address - Phone:615-797-5877
Practice Address - Fax:615-797-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty