Healthcare Provider Details

I. General information

NPI: 1386708642
Provider Name (Legal Business Name): MARION LEONARD MESSERSMITH DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 21ST AVENUE SOUTH VANDERBILT ORTHODONTIC CENTER
NASHVILLE TN
37212-8224
US

IV. Provider business mailing address

1500 21ST AVENUE SOUTH VANDERBILT ORTHODONTIC CENTER
NASHVILLE TN
37212-8224
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-0633
  • Fax: 615-343-1830
Mailing address:
  • Phone: 615-343-0633
  • Fax: 615-343-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8791
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: