Provider Demographics
NPI:1306083571
Name:TENNESSEE DENTAL PROFESSIONALS PC
Entity type:Organization
Organization Name:TENNESSEE DENTAL PROFESSIONALS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1926 HIGHWAY 46 S
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2754
Mailing Address - Country:US
Mailing Address - Phone:615-446-7050
Mailing Address - Fax:615-446-4699
Practice Address - Street 1:1926 HIGHWAY 46 S
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2754
Practice Address - Country:US
Practice Address - Phone:615-446-7050
Practice Address - Fax:615-446-4699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESSEE DENTAL PROFESSIONALS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-09
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty