Provider Demographics
NPI:1659668226
Name:PERIODONTAL CARE CENTER, PLLC
Entity Type:Organization
Organization Name:PERIODONTAL CARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN-MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-264-6404
Mailing Address - Street 1:100 SPRINGHOUSE CT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1609
Mailing Address - Country:US
Mailing Address - Phone:615-264-6404
Mailing Address - Fax:
Practice Address - Street 1:100 SPRINGHOUSE CT
Practice Address - Street 2:SUITE 220
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1609
Practice Address - Country:US
Practice Address - Phone:615-264-6404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty