Provider Demographics
NPI:1962636191
Name:THE DENTAL EDGE, P.C.
Entity Type:Organization
Organization Name:THE DENTAL EDGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:EDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-373-0642
Mailing Address - Street 1:PO BOX 306086
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6086
Mailing Address - Country:US
Mailing Address - Phone:615-373-0642
Mailing Address - Fax:615-370-0778
Practice Address - Street 1:5544 FRANKLIN PIKE STE 102
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-2127
Practice Address - Country:US
Practice Address - Phone:615-373-0642
Practice Address - Fax:615-370-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS022261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4140665OtherBLUE CROSS BLUE SHIELD