Healthcare Provider Details

I. General information

NPI: 1063359511
Provider Name (Legal Business Name): PROVISION FAMILY DENTAL, PLLC D/B/A FAIRVIEW FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7022 CITY CENTER WAY
FAIRVIEW TN
37062-6004
US

IV. Provider business mailing address

7022 CITY CENTER WAY
FAIRVIEW TN
37062-6004
US

V. Phone/Fax

Practice location:
  • Phone: 615-266-2645
  • Fax: 615-266-2639
Mailing address:
  • Phone: 615-266-2645
  • Fax: 615-266-2639

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: HUNTER FLEENOR
Title or Position: MEMBER
Credential: DDS
Phone: 615-424-2260