Provider Demographics
NPI:1689330623
Name:GATEWAY FAMILY DENTISTRY SEDATION AND IMPLANT PLLC
Entity Type:Organization
Organization Name:GATEWAY FAMILY DENTISTRY SEDATION AND IMPLANT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-962-8505
Mailing Address - Street 1:206 N THOMPSON LN STE A
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-4333
Mailing Address - Country:US
Mailing Address - Phone:615-624-6919
Mailing Address - Fax:
Practice Address - Street 1:206 N THOMPSON LN STE A
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4333
Practice Address - Country:US
Practice Address - Phone:615-624-6919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY FAMILY DENTISTRY SEDATION AND IMPLANT PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty