Provider Demographics
NPI:1588230031
Name:LIGNUM DENTISTRY, P.C.
Entity Type:Organization
Organization Name:LIGNUM DENTISTRY, P.C.
Other - Org Name:LIGNUM DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-930-0380
Mailing Address - Street 1:5295 MURFREESBORO RD
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2724
Mailing Address - Country:US
Mailing Address - Phone:615-930-0380
Mailing Address - Fax:
Practice Address - Street 1:5295 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2724
Practice Address - Country:US
Practice Address - Phone:615-930-0380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty