Provider Demographics
NPI:1679675052
Name:FAMILY & COSMETIC DENTISTRY OF SMYRNA
Entity Type:Organization
Organization Name:FAMILY & COSMETIC DENTISTRY OF SMYRNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:615-355-1062
Mailing Address - Street 1:780 NISSAN DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4407
Mailing Address - Country:US
Mailing Address - Phone:615-355-1062
Mailing Address - Fax:615-355-1933
Practice Address - Street 1:780 NISSAN DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4407
Practice Address - Country:US
Practice Address - Phone:615-355-1062
Practice Address - Fax:615-355-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty