Healthcare Provider Details

I. General information

NPI: 1174952642
Provider Name (Legal Business Name): PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLE TENNESSEE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 HILLSBORO PIKE STE. 101
NASHVILLE TN
37215-3381
US

IV. Provider business mailing address

4205 HILLSBORO PIKE STE. 101
NASHVILLE TN
37215-3381
US

V. Phone/Fax

Practice location:
  • Phone: 615-297-8973
  • Fax: 615-297-6603
Mailing address:
  • Phone: 615-297-8973
  • Fax: 615-297-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS007739
License Number StateTN

VIII. Authorized Official

Name: DR. ROBERT P PULLIAM
Title or Position: PERIODONTIST/OWNER
Credential: DMD, MS
Phone: 615-297-8973