Provider Demographics
NPI:1497058788
Name:DENTAL PRACTICE GROUP OF TENNESSEE, PLLC
Entity Type:Organization
Organization Name:DENTAL PRACTICE GROUP OF TENNESSEE, PLLC
Other - Org Name:DENTAL PARTNERS - BOWLING GREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-796-0382
Mailing Address - Street 1:296 S MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 S WHITE STATION RD STE 8
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4538
Practice Address - Country:US
Practice Address - Phone:901-747-4611
Practice Address - Fax:901-747-4636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PRACTICE GROUP OF TENNESSEE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-08
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
FLDN 14545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty