Provider Demographics
NPI:1326914136
Name:LIFE DENTAL TENNESSEE PLLC
Entity type:Organization
Organization Name:LIFE DENTAL TENNESSEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAIGNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-550-2310
Mailing Address - Street 1:105 HEADY DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-4403
Mailing Address - Country:US
Mailing Address - Phone:615-352-6684
Mailing Address - Fax:
Practice Address - Street 1:105 HEADY DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-4403
Practice Address - Country:US
Practice Address - Phone:615-352-6684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE DENTAL TENNESSEE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty