Provider Demographics
NPI:1467909929
Name:BELLE MEADE SMILE CENTER, PLLC
Entity Type:Organization
Organization Name:BELLE MEADE SMILE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:PALMER
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-292-4100
Mailing Address - Street 1:4515 HARDING PIKE, SUITE 312
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205
Mailing Address - Country:US
Mailing Address - Phone:615-292-4100
Mailing Address - Fax:615-292-4181
Practice Address - Street 1:4515 HARDING PIKE STE 312
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2197
Practice Address - Country:US
Practice Address - Phone:615-292-4100
Practice Address - Fax:615-292-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000071261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty