Provider Demographics
NPI:1356588495
Name:COSMETIC CREATIONS PLLC
Entity type:Organization
Organization Name:COSMETIC CREATIONS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:GUNNELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-448-7093
Mailing Address - Street 1:684 N MOUNT JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3323
Mailing Address - Country:US
Mailing Address - Phone:615-758-6800
Mailing Address - Fax:
Practice Address - Street 1:684 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3323
Practice Address - Country:US
Practice Address - Phone:615-758-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty