Provider Demographics
NPI:1912128117
Name:HEARTLAND DENTAL CARE OF TENNESSEE, PC
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF TENNESSEE, PC
Other - Org Name:ANTIOCH DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COOD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:5352 HICKORY HOLLOW PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013
Mailing Address - Country:US
Mailing Address - Phone:615-731-0889
Mailing Address - Fax:615-731-0869
Practice Address - Street 1:5352 HICKORY HOLLOW PARKWAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013
Practice Address - Country:US
Practice Address - Phone:615-731-0889
Practice Address - Fax:615-731-0869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF TENNESSEE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-02
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty