Provider Demographics
NPI:1598757361
Name:THE CHILDREN'S DENTIST
Entity Type:Organization
Organization Name:THE CHILDREN'S DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:LARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEEDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:931-551-4400
Mailing Address - Street 1:271 STONECROSSING DR STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8404
Mailing Address - Country:US
Mailing Address - Phone:931-551-4400
Mailing Address - Fax:931-591-3245
Practice Address - Street 1:271 STONECROSSING DR STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-8404
Practice Address - Country:US
Practice Address - Phone:931-551-4400
Practice Address - Fax:931-591-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty