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General NPI Number Information
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NPI Number | 1194307330
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Entity Type | Organization
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Legal Business Name | RED LEAF ORTHODONTICS PLLC
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 1414 JENKINS RD STE 146A
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3470
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Country | US
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Telephone | 423-541-3777
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 JENKINS RD STE 146A
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3470
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Country | US
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Telephone | 423-541-3777
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Fax |
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Authorized Official
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Title or Position | OWNER, DOCTOR
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Name | JEFFERSON TWOMLEY
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Credential | DDS, MSD
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Telephone | 504-239-2498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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