Healthcare Provider Details

I. General information

NPI: 1396472601
Provider Name (Legal Business Name): PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLE TENNESSEE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FORREST CROSSING BLVD. STE. #105B
FRANKLIN TN
37064-5430
US

IV. Provider business mailing address

101 FORREST CROSSING BLVD. STE. #105B
FRANKLIN TN
37064-5430
US

V. Phone/Fax

Practice location:
  • Phone: 615-794-4226
  • Fax:
Mailing address:
  • Phone: 615-794-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT P PULLIAM
Title or Position: PERIODONTIST/OWNER
Credential: DMD, MS
Phone: 615-794-4226