Healthcare Provider Details

I. General information

NPI: 1407000417
Provider Name (Legal Business Name): DARRYL T DEASON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAIN ST SUITE B
WOODBURY TN
37190-1047
US

IV. Provider business mailing address

801 W MAIN ST SUITE B
WOODBURY TN
37190-1047
US

V. Phone/Fax

Practice location:
  • Phone: 615-563-2266
  • Fax: 615-563-4258
Mailing address:
  • Phone: 615-563-2266
  • Fax: 615-563-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS3575
License Number StateTN

VIII. Authorized Official

Name: DR. DARRYL T DEASON
Title or Position: DENTIST
Credential: DDS
Phone: 615-563-2266