Provider Demographics
NPI:1356080352
Name:LIFE BRIDGE DENTAL TN PLLC
Entity type:Organization
Organization Name:LIFE BRIDGE DENTAL TN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR RCM
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-601-5250
Mailing Address - Street 1:970 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3722
Mailing Address - Country:US
Mailing Address - Phone:615-601-5250
Mailing Address - Fax:615-468-0325
Practice Address - Street 1:970 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3722
Practice Address - Country:US
Practice Address - Phone:615-601-5250
Practice Address - Fax:615-468-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty