MEDICARE: AMERICAN 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
1	122300000X	Dentist	DS7142	TN

General Provider Information

NPI Number	:	1871754820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DENTAL CENTER

Provider Business Mailing Address
First Line	:	617 WOODLAND ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-4211
Country	:	US
Telephone Number	:	615-256-2321
Fax Number	:	615-256-2329

Provider Business Practice Location Address
First Line	:	617 WOODLAND ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-4211
Country	:	US
Telephone Number	:	615-256-2321
Fax Number	:	615-256-2329

Authorized Official
Title or Position	:	DENTIST
Name	:	BENITA S JACKSON
Credential	:	DDS
Telephone Number	:	615-256-2321

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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