Healthcare Provider Details

I. General information

NPI: 1851894851
Provider Name (Legal Business Name): LOOK NASH DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GALLERIA BLVD
FRANKLIN TN
37067-1605
US

IV. Provider business mailing address

1651 SCHILLINGER RD N
SEMMES AL
36575-7409
US

V. Phone/Fax

Practice location:
  • Phone: 251-753-0197
  • Fax:
Mailing address:
  • Phone: 251-301-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BROOK VILLANUEVA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 251-301-9690