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General NPI Number Information
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NPI Number | 1063665040
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL CENTERS, PC
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 601 NW ATLANTIC ST SUITE A
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City | TULLAHOMA
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State | TN
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Zip | 37388-3536
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Country | US
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Telephone | 931-455-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 601 NW ATLANTIC ST SUITE A
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City | TULLAHOMA
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State | TN
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Zip | 37388-3536
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Country | US
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Telephone | 931-455-8003
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVE R. LYNN
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Credential | DDS
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Telephone | 931-455-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS0000005201
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License Number State | TN
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