Healthcare Provider Details

I. General information

NPI: 1063495372
Provider Name (Legal Business Name): JOHN M. DEDMON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 HIGH ST N
CARTHAGE TN
37030-1429
US

IV. Provider business mailing address

1007 BENTON HARBOR BLVD.
MT.JULIET TN
37112
US

V. Phone/Fax

Practice location:
  • Phone: 615-735-0242
  • Fax: 615-735-8250
Mailing address:
  • Phone: 931-646-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0000001742
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: