Healthcare Provider Details

I. General information

NPI: 1114131943
Provider Name (Legal Business Name): ROBERT CHARLES SJURSEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 FIELDSTONE PKWY SUITE 400
FRANKLIN TN
37069-4337
US

IV. Provider business mailing address

2020 FIELDSTONE PKWY SUITE 400
FRANKLIN TN
37069-4337
US

V. Phone/Fax

Practice location:
  • Phone: 615-591-5995
  • Fax: 615-591-5994
Mailing address:
  • Phone: 615-591-5995
  • Fax: 615-591-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7288
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: