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General NPI Number Information
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NPI Number | 1013876515
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Entity Type | Organization
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Legal Business Name | BLACK DIAMOND PARTNERS, PLLC
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Dates
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Enumeration Date | 01/20/2026
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 2516 TN-49 STE. 101
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City | PLEASANT VIEW
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State | TN
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Zip | 37146
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Country | US
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Telephone | 615-649-4155
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Fax |
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Provider Business Mailing Address
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Address Line | 2516 TN-49 STE. 101
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City | PLEASANT VIEW
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State | TN
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Zip | 37146
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Country | US
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Telephone | 615-649-4155
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. WILLIAM JOHN AXTELL
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Credential | DMD
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Telephone | 270-977-3112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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