Healthcare Provider Details

I. General information

NPI: 1063585404
Provider Name (Legal Business Name): OP DENTAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4718 NOLENSVILLE PIKE
NASHVILLE TN
37211-5408
US

IV. Provider business mailing address

4718 NOLENSVILLE PIKE
NASHVILLE TN
37211-5408
US

V. Phone/Fax

Practice location:
  • Phone: 615-333-2833
  • Fax: 615-333-2863
Mailing address:
  • Phone: 615-333-2833
  • Fax: 615-333-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS3729
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS3842
License Number StateTN

VIII. Authorized Official

Name: DR. MELVIN S POLK JR.
Title or Position: SECRETARY TREASURER
Credential: DDS MS
Phone: 615-333-2833