Healthcare Provider Details

I. General information

NPI: 1427407733
Provider Name (Legal Business Name): CUMBERLAND PEDIATRIC DENTISTRY AND ORTHODONTICS OF MURFREESBORO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 PRESIDENT PL STE 200
SMYRNA TN
37167-6844
US

IV. Provider business mailing address

277 VETERANS PKWY SUITE A
MURFREESBORO TN
37128-6930
US

V. Phone/Fax

Practice location:
  • Phone: 615-220-6161
  • Fax:
Mailing address:
  • Phone: 615-220-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LYNN GOINGS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 615-220-6161