Provider Demographics
NPI:1992032221
Name:VILLAGE DENTAL GROUP
Entity Type:Organization
Organization Name:VILLAGE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-498-4323
Mailing Address - Street 1:112 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE B226
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8913
Mailing Address - Country:US
Mailing Address - Phone:615-822-2626
Mailing Address - Fax:615-822-3626
Practice Address - Street 1:112 SAUNDERSVILLE RD
Practice Address - Street 2:SUITE B226
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-8913
Practice Address - Country:US
Practice Address - Phone:615-822-2626
Practice Address - Fax:615-822-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty