Provider Demographics
NPI:1528210382
Name:TENNESSEE DENTAL PROFESSIONALS PC
Entity Type:Organization
Organization Name:TENNESSEE DENTAL PROFESSIONALS PC
Other - Org Name:FARMINGTON DENTAL CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COORD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1918 EXETER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2970
Mailing Address - Country:US
Mailing Address - Phone:901-755-2100
Mailing Address - Fax:901-755-2490
Practice Address - Street 1:1918 EXETER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2970
Practice Address - Country:US
Practice Address - Phone:901-755-2100
Practice Address - Fax:901-755-2490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESSEE DENTAL PROFESSIONALS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-10
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty