Provider Demographics
NPI:1619338886
Name:CROSSVILLE DENTISTRY PLLC
Entity Type:Organization
Organization Name:CROSSVILLE DENTISTRY PLLC
Other - Org Name:CROSSVILLE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:HUBBELL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-231-2430
Mailing Address - Street 1:15 PARKSIDE PLACE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555
Mailing Address - Country:US
Mailing Address - Phone:931-456-2236
Mailing Address - Fax:865-947-7906
Practice Address - Street 1:15 PARKSIDE PLACE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555
Practice Address - Country:US
Practice Address - Phone:931-456-2236
Practice Address - Fax:865-947-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty