Provider Demographics
NPI:1518542760
Name:TULLAHOMA FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:TULLAHOMA FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-720-9549
Mailing Address - Street 1:304 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3750
Mailing Address - Country:US
Mailing Address - Phone:931-461-9030
Mailing Address - Fax:
Practice Address - Street 1:304 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3750
Practice Address - Country:US
Practice Address - Phone:931-461-9030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922314566OtherNATALIE GERMAIN NPI NUMBER
1366758906OtherBRETT GERMAIN NPI NUMBER
1528137742OtherCHRISTOPHER ANDERSON NPI NUMBER