Provider Demographics
NPI:1730457326
Name:CHILDREN'S DENTISTRY OF SMYRNA
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY OF SMYRNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-930-3718
Mailing Address - Street 1:739 PRESIDENTS PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167
Mailing Address - Country:US
Mailing Address - Phone:615-220-6161
Mailing Address - Fax:615-220-6116
Practice Address - Street 1:1540 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6141
Practice Address - Country:US
Practice Address - Phone:615-220-6161
Practice Address - Fax:615-220-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN92041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty