Provider Demographics
NPI:1841383437
Name:TEAM POPP DENTAL, PLLC
Entity Type:Organization
Organization Name:TEAM POPP DENTAL, PLLC
Other - Org Name:DR THOMAS W POPP ORTHODONTIC SPECIALIST, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:POPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:423-870-8787
Mailing Address - Street 1:4211 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415
Mailing Address - Country:US
Mailing Address - Phone:423-870-8787
Mailing Address - Fax:423-875-6489
Practice Address - Street 1:4211 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415
Practice Address - Country:US
Practice Address - Phone:423-870-8787
Practice Address - Fax:423-875-6489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7499386OtherUNITED CONCORDIA
TN0017078OtherDORAL
TN0017079OtherDORAL
TN0039969OtherBCBS OF TN
TN4024712OtherBCBS OF TN
TN3072971OtherBCBS OF TN
TN820674OtherUNITED CONCORDIA