Provider Demographics
NPI:1497269617
Name:A FANCY CHEEZE LLC.
Entity Type:Organization
Organization Name:A FANCY CHEEZE LLC.
Other - Org Name:A FANCY CHEEZE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHALAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FURLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-554-7422
Mailing Address - Street 1:1004 TABITHA LN
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-2361
Mailing Address - Country:US
Mailing Address - Phone:615-554-7422
Mailing Address - Fax:
Practice Address - Street 1:6522 HIGHWAY 41A
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-8162
Practice Address - Country:US
Practice Address - Phone:615-397-4784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A FANCY CHEEZE LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service