MEDICARE: ABC FAMILY DENTAL CENTER P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7784	TN

General Provider Information

NPI Number	:	1063595692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC FAMILY DENTAL CENTER P.C.

Provider Business Mailing Address
First Line	:	1877 FORT CAMPBELL BLVD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-5109
Country	:	US
Telephone Number	:	931-648-0191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1877 FORT CAMPBELL BLVD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-5109
Country	:	US
Telephone Number	:	931-648-0191
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HEATH CUNNINGHAM
Credential	:	DDS
Telephone Number	:	931-648-0191

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	10/15/2012

Similar Medicare Providers

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Practice Location Address:

1877 FORT CAMPBELL BLVD
CLARKSVILLE, TN
37042-5109

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Practice Fax: 931-648-4235

1508856238 — DR. RICHARD DONALD WARRINGTON D.M.D.
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1245220961 — HEATH LEE CUNNINGHAM DDS
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37042-5109

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1265983639 — FORT CAMPBELL CHIROPRACTIC PLLC
Practice Location Address:

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1790442366 — DEPAUL NICHOLS
Practice Location Address:

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1912756487 — FRANCIS FAMILY DENTAL LLC
Practice Location Address:

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Practice Fax:

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