Provider Demographics
NPI:1528216231
Name:SOMERVILLE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SOMERVILLE DENTAL ASSOCIATES
Other - Org Name:BARTLETT DENTAL ASSOCIATES, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-388-9883
Mailing Address - Street 1:305 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-9718
Mailing Address - Country:US
Mailing Address - Phone:901-465-2714
Mailing Address - Fax:901-465-6266
Practice Address - Street 1:305 LAKE DR
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-9718
Practice Address - Country:US
Practice Address - Phone:901-465-2714
Practice Address - Fax:901-465-6266
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARTLETT DENTAL ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty