Provider Demographics
NPI:1477032050
Name:SOUTHERN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SOUTHERN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-686-1151
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-0163
Mailing Address - Country:US
Mailing Address - Phone:731-686-1151
Mailing Address - Fax:731-613-2133
Practice Address - Street 1:2025 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3004
Practice Address - Country:US
Practice Address - Phone:731-686-1151
Practice Address - Fax:731-613-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN89061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty