Provider Demographics
NPI:1912217142
Name:ESTILL SPRINGS FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:ESTILL SPRINGS FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-649-3238
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-0515
Mailing Address - Country:US
Mailing Address - Phone:931-649-3238
Mailing Address - Fax:931-649-3240
Practice Address - Street 1:802 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ESTILL SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37330-3212
Practice Address - Country:US
Practice Address - Phone:931-649-3238
Practice Address - Fax:931-649-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty