Provider Demographics
NPI:1831666379
Name:CHATTANOOGA CENTER COMP. CENTER
Entity Type:Organization
Organization Name:CHATTANOOGA CENTER COMP. CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:CARICO
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-756-1540
Mailing Address - Street 1:830 CHEROKEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3312
Mailing Address - Country:US
Mailing Address - Phone:423-756-1540
Mailing Address - Fax:423-756-3462
Practice Address - Street 1:830 CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3312
Practice Address - Country:US
Practice Address - Phone:423-756-1540
Practice Address - Fax:423-756-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental