Healthcare Provider Details

I. General information

NPI: 1306570619
Provider Name (Legal Business Name): VIBE DENTAL OF ANTIOCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5357 MOUNT VIEW RD
ANTIOCH TN
37013-2308
US

IV. Provider business mailing address

317 S 2ND ST
PULASKI TN
38478-3842
US

V. Phone/Fax

Practice location:
  • Phone: 615-731-8960
  • Fax:
Mailing address:
  • Phone: 615-512-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NATHAN W OWENS
Title or Position: OWNER
Credential: DMD
Phone: 931-363-1388