Provider Demographics
NPI:1851904338
Name:SOUTH NASHVILLE DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SOUTH NASHVILLE DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-331-5977
Mailing Address - Street 1:15576 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7330
Mailing Address - Country:US
Mailing Address - Phone:615-331-5977
Mailing Address - Fax:615-331-5978
Practice Address - Street 1:15576 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-7330
Practice Address - Country:US
Practice Address - Phone:615-331-5977
Practice Address - Fax:615-331-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty