MEDICARE: HANCOCK DENTISTRY HILLSBORO VILLAGE

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1346719036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANCOCK DENTISTRY HILLSBORO VILLAGE

Provider Business Mailing Address
First Line	:	2505 21ST AVE S STE 101
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-5652
Country	:	US
Telephone Number	:	615-292-8010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 21ST AVE S STE 101
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-5652
Country	:	US
Telephone Number	:	615-292-8010
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JERRY HANCOCK
Credential	:	DMD
Telephone Number	:	615-292-8010

Provider Enumeration Date	:	11/25/2018
Last Update Date	:	11/25/2018

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Directions to “HANCOCK DENTISTRY HILLSBORO VILLAGE ” Practice Location

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