Healthcare Provider Details

I. General information

NPI: 1396681557
Provider Name (Legal Business Name): MDG TENNESSEE CLINICAL ENTITIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E COLLEGE ST STE C
DICKSON TN
37055-1893
US

IV. Provider business mailing address

785 OLD HICKORY BLVD STE 100
BRENTWOOD TN
37027-4512
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-7878
  • Fax:
Mailing address:
  • Phone: 615-373-5930
  • 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: SKYLOR MORTON
Title or Position: OWNER
Credential: DDS
Phone: 615-970-2300