Provider Demographics
NPI:1508292269
Name:PROMISE DENTAL
Entity Type:Organization
Organization Name:PROMISE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR'S WIFE
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-401-1103
Mailing Address - Street 1:2908 SIDCO DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3759
Mailing Address - Country:US
Mailing Address - Phone:615-401-1103
Mailing Address - Fax:615-678-4381
Practice Address - Street 1:2908 SIDCO DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3759
Practice Address - Country:US
Practice Address - Phone:615-401-1103
Practice Address - Fax:615-678-4381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS31341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty