Provider Demographics
NPI:1679942155
Name:UPPER CUMBERLAND FAMILY DENTISTRY
Entity Type:Organization
Organization Name:UPPER CUMBERLAND FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-823-5517
Mailing Address - Street 1:215 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1726
Mailing Address - Country:US
Mailing Address - Phone:931-823-5517
Mailing Address - Fax:931-823-3852
Practice Address - Street 1:554 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALGOOD
Practice Address - State:TN
Practice Address - Zip Code:38506
Practice Address - Country:US
Practice Address - Phone:931-537-2254
Practice Address - Fax:931-537-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty