Provider Demographics
NPI:1457524647
Name:WELLSPRING ORTHODONTICS, PC
Entity type:Organization
Organization Name:WELLSPRING ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-771-3535
Mailing Address - Street 1:360 COOL SPRINGS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7215
Mailing Address - Country:US
Mailing Address - Phone:615-771-3535
Mailing Address - Fax:615-771-1998
Practice Address - Street 1:104 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6408
Practice Address - Country:US
Practice Address - Phone:866-771-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS73611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty