Healthcare Provider Details

I. General information

NPI: 1932789880
Provider Name (Legal Business Name): KIDS DENTAL CENTER, GP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MOUSE CREEK RD NW
CLEVELAND TN
37312-3818
US

IV. Provider business mailing address

4610 BRAINERD RD STE 3
CHATTANOOGA TN
37411-3835
US

V. Phone/Fax

Practice location:
  • Phone: 423-458-4147
  • Fax: 423-476-2680
Mailing address:
  • Phone: 423-541-5500
  • Fax: 423-476-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHAD STEVEN ESLINGER
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 423-541-5500