Provider Demographics
NPI:1609281724
Name:COMPLETE FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:COMPLETE FAMILY DENTISTRY, PLLC
Other - Org Name:PARAMOUNT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SHADIX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-612-6015
Mailing Address - Street 1:112 SAUNDERSVILLE RD BLDG B
Mailing Address - Street 2:SUITE B-226
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8943
Mailing Address - Country:US
Mailing Address - Phone:615-447-3672
Mailing Address - Fax:615-447-3715
Practice Address - Street 1:112 SAUNDERSVILLE RD BLDG B
Practice Address - Street 2:SUITE B-226
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-8943
Practice Address - Country:US
Practice Address - Phone:615-447-3672
Practice Address - Fax:615-447-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty