=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043944911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HONEST SMILES NASHVILLE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2022
-----------------------------------------------------
Last Update Date | 07/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4928 EDMONDSON PIKE STE 202
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37211-4791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-837-2004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1441 NEW HIGHWAY 96 W STE 2-202
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37064-4830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-801-0125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNTANT
-----------------------------------------------------
Name | ANDREW CRAIG CHAMBERLAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-991-8266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------