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General NPI Number Information
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NPI Number | 1275707853
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Entity Type | Organization
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Legal Business Name | PROSPERITY COSMETIC & GENERAL DENTISTRY
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 908 34TH AVE N SUITE A
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City | NASHVILLE
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State | TN
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Zip | 37209-2502
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Country | US
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Telephone | 615-720-3765
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Fax | 615-327-0546
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Provider Business Mailing Address
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Address Line | 908 34TH AVE N SUITE A
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City | NASHVILLE
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State | TN
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Zip | 37209-2502
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Country | US
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Telephone | 615-720-3765
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Fax | 615-327-0546
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRENDA LESIA MOORE II
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Credential | DDS
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Telephone | 615-720-3765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 8455
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License Number State | TN
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