Provider Demographics
NPI:1023268828
Name:MONROE COUNTY DENTAL CLINIC
Entity type:Organization
Organization Name:MONROE COUNTY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-337-1147
Mailing Address - Street 1:3469 NEW HIGHWAY 68
Mailing Address - Street 2:P.O. BOX 398
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-5148
Mailing Address - Country:US
Mailing Address - Phone:423-442-8828
Mailing Address - Fax:423-442-3677
Practice Address - Street 1:3469 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-5148
Practice Address - Country:US
Practice Address - Phone:423-442-8828
Practice Address - Fax:423-442-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty