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General NPI Number Information
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NPI Number | 1164261822
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Entity Type | Organization
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Legal Business Name | EVOLVE DENTAL MEDSPA
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 1210 HAZELWOOD DR STE B
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City | SMYRNA
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State | TN
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Zip | 37167-3964
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Country | US
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Telephone | 615-930-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 415 AVONDALE DR
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City | NASHVILLE
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State | TN
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Zip | 37206-1818
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Country | US
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Telephone | 615-584-3861
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS ALEXA LANVIN
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Credential |
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Telephone | 615-930-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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