Provider Demographics
NPI:1831658012
Name:SOH OF TENNESSEE PLLC
Entity Type:Organization
Organization Name:SOH OF TENNESSEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-753-8154
Mailing Address - Street 1:317 SEVEN SPRINGS WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4991
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 SEVEN SPRINGS WAY STE 204
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4991
Practice Address - Country:US
Practice Address - Phone:615-373-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty