Provider Demographics
NPI:1609653260
Name:TENNESSEE DENTAL PROFESSIONALS, PC
Entity Type:Organization
Organization Name:TENNESSEE DENTAL PROFESSIONALS, PC
Other - Org Name:AIRLINE ROAD DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:5261 AIRLINE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4267
Mailing Address - Country:US
Mailing Address - Phone:901-290-0885
Mailing Address - Fax:901-290-0871
Practice Address - Street 1:5261 AIRLINE RD
Practice Address - Street 2:STE 102
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4267
Practice Address - Country:US
Practice Address - Phone:901-290-0885
Practice Address - Fax:901-290-0871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESSEE DENTAL PROFESSIONALS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-08
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty