Healthcare Provider Details

I. General information

NPI: 1780415893
Provider Name (Legal Business Name): FRANK ANTHONY LICHT RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 08/10/2024
Certification Date: 08/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 MARRIOTT DR
NASHVILLE TN
37214-5048
US

IV. Provider business mailing address

5609 GLENALDEN DR
SMYRNA TN
37167-3376
US

V. Phone/Fax

Practice location:
  • Phone: 629-802-3230
  • Fax:
Mailing address:
  • Phone: 615-416-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5808
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: