Healthcare Provider Details

I. General information

NPI: 1942796479
Provider Name (Legal Business Name): ADESEYE AWE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD STE 300
HERMITAGE TN
37076-2057
US

IV. Provider business mailing address

5651 FRIST BLVD STE 300
HERMITAGE TN
37076-2057
US

V. Phone/Fax

Practice location:
  • Phone: 615-889-7835
  • Fax: 615-889-7837
Mailing address:
  • Phone: 615-889-7835
  • Fax: 615-889-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10995
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: