MEDICARE: CAMPBELL STATION DENTISTRY INC

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	TNDS7323	TN

General Provider Information

NPI Number	:	1194873307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELL STATION DENTISTRY INC

Provider Business Mailing Address
First Line	:	4910 COLUMBIA PIKE
Second Line	:	SUITE 106
City	:	SPRING HILL
State	:	TN
Zip	:	37174-4200
Country	:	US
Telephone Number	:	615-302-3444
Fax Number	:	615-302-3445

Provider Business Practice Location Address
First Line	:	4910 COLUMBIA PIKE
Second Line	:	SUITE 106
City	:	SPRING HILL
State	:	TN
Zip	:	37174-4200
Country	:	US
Telephone Number	:	615-302-3444
Fax Number	:	615-302-3445

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIE STRAIN NEWBERRY
Credential	:	DDS
Telephone Number	:	615-302-3444

Provider Enumeration Date	:	01/07/2007
Last Update Date	:	08/22/2020

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