Healthcare Provider Details

I. General information

NPI: 1396369054
Provider Name (Legal Business Name): JOHN THOMAS HOUSTON IV DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 COOL SPRINGS BLVD # 140
FRANKLIN TN
37067-6474
US

IV. Provider business mailing address

700 12TH AVE S UNIT 1107
NASHVILLE TN
37203-3431
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-1111
  • Fax:
Mailing address:
  • Phone: 214-980-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number33533
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: