Healthcare Provider Details

I. General information

NPI: 1720903008
Provider Name (Legal Business Name): LIFE DENTAL TENNESSEE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAYFIELD DR
SMYRNA TN
37167-3017
US

IV. Provider business mailing address

100 MAYFIELD DR
SMYRNA TN
37167-3017
US

V. Phone/Fax

Practice location:
  • Phone: 615-459-3366
  • Fax:
Mailing address:
  • Phone: 615-459-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LAUREN S DAIGNEAULT
Title or Position: ADMINISTRATIVE & REVENUE CYCLE DIRE
Credential:
Phone: 662-550-2310