Healthcare Provider Details

I. General information

NPI: 1578892493
Provider Name (Legal Business Name): LAVERGNE SMILES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5168 MURFREESBORO RD
LA VERGNE TN
37086-2712
US

IV. Provider business mailing address

5168 MURFREESBORO RD
LA VERGNE TN
37086-2712
US

V. Phone/Fax

Practice location:
  • Phone: 615-793-7932
  • Fax: 615-213-6301
Mailing address:
  • Phone: 615-793-7932
  • Fax: 615-213-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDS4095
License Number StateTN

VIII. Authorized Official

Name: ARVIND K PATEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 615-793-7932