Provider Demographics
NPI:1649993874
Name:VIBE DENTAL OF FAIRVIEW
Entity type:Organization
Organization Name:VIBE DENTAL OF FAIRVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-205-6838
Mailing Address - Street 1:317 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-3842
Mailing Address - Country:US
Mailing Address - Phone:931-205-6838
Mailing Address - Fax:
Practice Address - Street 1:1696 FAIRVIEW BLVD STE 104
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-5144
Practice Address - Country:US
Practice Address - Phone:615-799-9234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty