Provider Demographics
NPI:1740554518
Name:DYNAMIC DENTISTRY LLC
Entity type:Organization
Organization Name:DYNAMIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBURGEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-474-1329
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37111-0191
Mailing Address - Country:US
Mailing Address - Phone:931-474-1329
Mailing Address - Fax:931-474-1330
Practice Address - Street 1:24 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-3362
Practice Address - Country:US
Practice Address - Phone:931-474-1329
Practice Address - Fax:931-474-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental