Provider Demographics
NPI:1760162093
Name:386 DENTAL STUDIO
Entity Type:Organization
Organization Name:386 DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SKYLOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-970-2300
Mailing Address - Street 1:120 GOODVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3125
Mailing Address - Country:US
Mailing Address - Phone:615-675-0555
Mailing Address - Fax:
Practice Address - Street 1:120 GOODVIEW WAY STE B
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3125
Practice Address - Country:US
Practice Address - Phone:615-675-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty