Provider Demographics
NPI:1619361441
Name:PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLET TENNESSEE, PLLC
Entity Type:Organization
Organization Name:PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLET TENNESSEE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:615-988-2603
Mailing Address - Street 1:1177 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4241
Mailing Address - Country:US
Mailing Address - Phone:615-988-2603
Mailing Address - Fax:615-988-2661
Practice Address - Street 1:1177 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4241
Practice Address - Country:US
Practice Address - Phone:615-988-2603
Practice Address - Fax:615-988-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty