Provider Demographics
NPI:1003486267
Name:HENDERSONVILLE IMPERIAL DENTAL CARE
Entity type:Organization
Organization Name:HENDERSONVILLE IMPERIAL DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-822-0833
Mailing Address - Street 1:107 IMPERIAL BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3492
Mailing Address - Country:US
Mailing Address - Phone:615-822-0833
Mailing Address - Fax:615-590-7943
Practice Address - Street 1:537 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-822-0833
Practice Address - Fax:615-590-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty