=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114496486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTISTRY BY ELIAS L HANOSH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2018
-----------------------------------------------------
Last Update Date | 11/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 934 OLDHAM DR STE 100
-----------------------------------------------------
City | NOLENSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37135-8472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-819-2571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 934 OLDHAM DR STE 100
-----------------------------------------------------
City | NOLENSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37135-8472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-819-2571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHERINA CHAWDHERY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-314-3646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------