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General NPI Number Information
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NPI Number | 1336255058
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN DENTAL ASSOCIATES, PC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 225 MAIN ST SUITE 400
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City | DAYTON
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State | TN
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Zip | 37321-1329
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Country | US
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Telephone | 423-775-1444
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Fax | 423-775-1103
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Provider Business Mailing Address
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Address Line | 225 MAIN ST SUITE 400
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City | DAYTON
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State | TN
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Zip | 37321-1329
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Country | US
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Telephone | 423-775-1444
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Fax | 423-775-1103
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS JAMES VAN METER
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Credential | DMD
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Telephone | 423-775-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7349
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License Number State | TN
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