Provider Demographics
NPI:1811566599
Name:MASSA, DOMINICK RINALDO
Entity type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:RINALDO
Last Name:MASSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 MORNING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-5715
Mailing Address - Country:US
Mailing Address - Phone:615-839-8665
Mailing Address - Fax:
Practice Address - Street 1:120 DONELSON PIKE STE 103
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2911
Practice Address - Country:US
Practice Address - Phone:615-839-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN11873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program