Healthcare Provider Details

I. General information

NPI: 1992107775
Provider Name (Legal Business Name): MURFREESBORO DENTAL EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 S RUTHERFORD BLVD STE A
MURFREESBORO TN
37130-0722
US

IV. Provider business mailing address

1754 S RUTHERFORD BLVD STE A
MURFREESBORO TN
37130-0722
US

V. Phone/Fax

Practice location:
  • Phone: 615-849-1293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS0000009931
License Number StateTN

VIII. Authorized Official

Name: ROBERT SCHOTT
Title or Position: DENTIST
Credential:
Phone: 615-849-1292