Provider Demographics
NPI:1356954838
Name:LA VERGNE DENTAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:LA VERGNE DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-280-2667
Mailing Address - Street 1:6001 JACKSON SQUARE BLVD STE 1001
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2768
Mailing Address - Country:US
Mailing Address - Phone:615-260-2667
Mailing Address - Fax:615-280-6615
Practice Address - Street 1:6001 JACKSON SQUARE BLVD STE 1001
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2768
Practice Address - Country:US
Practice Address - Phone:615-260-2667
Practice Address - Fax:615-280-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty