Healthcare Provider Details

I. General information

NPI: 1306488622
Provider Name (Legal Business Name): CUMBERLAND PEDIATRIC DENTISTRY AND ORTHODONTICS OF COOL SPRINGS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 LIBERTY PIKE SUITE 202-B
FRANKLIN TN
37067
US

IV. Provider business mailing address

1540 ROCK SPRINGS ROAD
SMYRNA TN
37167
US

V. Phone/Fax

Practice location:
  • Phone: 615-930-3718
  • Fax: 615-625-3473
Mailing address:
  • Phone: 615-390-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CAROL LYNN GOINGS
Title or Position: COO
Credential: DO
Phone: 615-478-7166