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NPI Code Detail

MEDICARE: TOTAL DENTAL CENTER

MEDICARE: TOTAL DENTAL CENTER
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
11223G0001XGeneral Practice Dentistry2526TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1108283OTHERTNDORAL TENNCARE

General Provider Information

NPI Number : 1528239589
Entity Type Code : Organization
Provider Name (Legal Business Name) : TOTAL DENTAL CENTER
Provider Business Mailing Address
First Line : 108 LIFESTYLE WAY
Second Line :
City : BENTON
State : TN
Zip : 37307-3914
Country : US
Telephone Number : 423-338-7777
Fax Number : 423-338-9326
Provider Business Practice Location Address
First Line : 108 LIFESTYLE WAY
Second Line :
City : BENTON
State : TN
Zip : 37307-3914
Country : US
Telephone Number : 423-338-7777
Fax Number : 423-338-9326
Authorized Official
Title or Position : MANAGER
Name : MRS. LYNORA JANE SINES
Credential : BS, RN, MPH
Telephone Number : 423-338-7777
Provider Enumeration Date : 03/18/2008
Last Update Date : 03/18/2008

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Directions to “TOTAL DENTAL CENTER ” Practice Location

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