Provider Demographics
NPI:1518299676
Name:SARA B NORTHCUTT DDS FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:SARA B NORTHCUTT DDS FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:AVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-790-4994
Mailing Address - Street 1:1441 NEW HWY 96 WEST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064
Mailing Address - Country:US
Mailing Address - Phone:615-790-4994
Mailing Address - Fax:615-656-2178
Practice Address - Street 1:1441 NEW HWY 96 WEST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064
Practice Address - Country:US
Practice Address - Phone:615-790-4994
Practice Address - Fax:615-656-2178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARA B. NORTHCUTT DDS FAMILY & COSMETIC DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7885122300000X
TN8268122300000X
TN9003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty