Provider Demographics
NPI:1396563946
Name:DENTISTRY OF LEWISBURG
Entity type:Organization
Organization Name:DENTISTRY OF LEWISBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SKYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-970-2300
Mailing Address - Street 1:20 OLD PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3879
Mailing Address - Country:US
Mailing Address - Phone:615-970-2300
Mailing Address - Fax:
Practice Address - Street 1:1360 S ELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-4324
Practice Address - Country:US
Practice Address - Phone:931-308-4292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST NASHVILLE AESTHETIC DENTISTRY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental