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General NPI Number Information
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NPI Number | 1164082871
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Entity Type | Organization
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Legal Business Name | ORTHODONTISTS OF MIDDLE TN
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 3130 TOM AUSTIN HWY STE D
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City | SPRINGFIELD
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State | TN
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Zip | 37172-4519
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Country | US
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Telephone | 615-384-2484
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 TOM AUSTIN HWY STE D
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City | SPRINGFIELD
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State | TN
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Zip | 37172-4519
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Country | US
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Telephone | 615-384-2484
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Fax |
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Authorized Official
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Title or Position | DR/ ORTHODONTIST
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Name | DR. CANDICE COLEMAN
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Credential | DDS, MDS
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Telephone | 901-361-4116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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