Provider Demographics
NPI:1669135646
Name:POWELL FAMILY DENTISTRY
Entity type:Organization
Organization Name:POWELL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-268-6262
Mailing Address - Street 1:7315 CLINTON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5225
Mailing Address - Country:US
Mailing Address - Phone:615-268-6262
Mailing Address - Fax:
Practice Address - Street 1:7315 CLINTON HWY STE A
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-5225
Practice Address - Country:US
Practice Address - Phone:615-268-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental