Healthcare Provider Details

I. General information

NPI: 1174004170
Provider Name (Legal Business Name): INTEGRITY MOBILE DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S CREST RD
CHATTANOOGA TN
37404-5923
US

IV. Provider business mailing address

802 S CREST RD
CHATTANOOGA TN
37404-5923
US

V. Phone/Fax

Practice location:
  • Phone: 855-535-5030
  • Fax: 855-535-5030
Mailing address:
  • Phone: 855-535-5030
  • Fax: 855-535-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDS8806
License Number StateTN

VIII. Authorized Official

Name: JENNIFER SUMMITT
Title or Position: CEO
Credential:
Phone: 855-535-5030