Provider Demographics
NPI:1578892915
Name:TENNESSEE DENTAL PROFESSIONALS, PC
Entity Type:Organization
Organization Name:TENNESSEE DENTAL PROFESSIONALS, PC
Other - Org Name:CANE RIDGE DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ALL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:1315 BELL ROAD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3077
Mailing Address - Country:US
Mailing Address - Phone:615-717-0507
Mailing Address - Fax:
Practice Address - Street 1:1315 BELL ROAD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3077
Practice Address - Country:US
Practice Address - Phone:615-717-0507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESSEE DENTAL PROFESSIONALS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-14
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty