Healthcare Provider Details

I. General information

NPI: 1497666390
Provider Name (Legal Business Name): ORTHO DENTAL LAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 ANTIOCH PIKE STE 105
ANTIOCH TN
37013-3479
US

IV. Provider business mailing address

1530 ANTIOCH PIKE STE 105
ANTIOCH TN
37013-3479
US

V. Phone/Fax

Practice location:
  • Phone: 855-604-7052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DAVID KATZMAN
Title or Position: MEMBER
Credential:
Phone: 855-604-7052