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General NPI Number Information
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NPI Number | 1285191767
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Entity Type | Organization
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Legal Business Name | MH DMD OF TENNESSEE, PLLC
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 2126 ABBOTT MARTIN RD STE 168
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City | NASHVILLE
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State | TN
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Zip | 37215-2619
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Country | US
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Telephone | 800-674-9732
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Fax |
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Provider Business Mailing Address
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Address Line | 2126 ABBOTT MARTIN RD STE 168
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City | NASHVILLE
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State | TN
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Zip | 37215-2619
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Country | US
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Telephone | 650-649-9497
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MR. MARTIN BREMER
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Credential |
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Telephone | 650-649-9497
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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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