Provider Demographics
NPI:1982021291
Name:HERITAGE PARK ENDODONTICS
Entity Type:Organization
Organization Name:HERITAGE PARK ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ARANG
Authorized Official - Last Name:KIM-PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-896-3686
Mailing Address - Street 1:538 BRANDIES CIR
Mailing Address - Street 2:STE 105
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-7698
Mailing Address - Country:US
Mailing Address - Phone:615-896-3686
Mailing Address - Fax:615-896-3645
Practice Address - Street 1:538 BRANDIES CIR
Practice Address - Street 2:STE 105
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-7698
Practice Address - Country:US
Practice Address - Phone:615-896-3686
Practice Address - Fax:615-896-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN75861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1760506091OtherINDIVIDUAL NATIONAL PROVIDER ID