Provider Demographics
NPI:1972756286
Name:HEARTLAND DENTAL CARE OF TN, PC
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF TN, PC
Other - Org Name:INDIAN LAKE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:209 INDIAN LAKE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-824-2926
Mailing Address - Fax:615-824-6608
Practice Address - Street 1:209 INDIAN LAKE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-824-2926
Practice Address - Fax:615-824-6608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF TN, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty