Provider Demographics
NPI:1619379963
Name:RICHLAND CREEK DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:RICHLAND CREEK DENTAL GROUP, PLLC
Other - Org Name:DENTISTRY OF NASHVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-477-5815
Mailing Address - Street 1:2125 BLAKEMORE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3505
Mailing Address - Country:US
Mailing Address - Phone:615-383-3690
Mailing Address - Fax:615-383-3697
Practice Address - Street 1:2125 BLAKEMORE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3505
Practice Address - Country:US
Practice Address - Phone:615-383-3690
Practice Address - Fax:615-383-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7873261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental