Provider Demographics
NPI:1598311573
Name:RESTORATION DENTISTRY
Entity Type:Organization
Organization Name:RESTORATION DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:NORVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS, CDT
Authorized Official - Phone:615-804-3960
Mailing Address - Street 1:1984 PROVIDENCE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4459
Mailing Address - Country:US
Mailing Address - Phone:615-257-7723
Mailing Address - Fax:
Practice Address - Street 1:1984 PROVIDENCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4459
Practice Address - Country:US
Practice Address - Phone:615-257-7723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty