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General NPI Number Information
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NPI Number | 1346474541
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Entity Type | Organization
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Legal Business Name | TULLAHOMA DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 1958 N JACKSON ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-2204
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Country | US
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Telephone | 931-454-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 1958 N. JACKSON ST.
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City | TULLAHOMA
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State | TN
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Zip | 37388
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Country | US
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Telephone | 931-454-0001
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Fax | 931-454-0973
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN ERIC SCALLIONS
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Credential | D.D.S.
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Telephone | 931-454-0001
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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 | 4464
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7889
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License Number State | TN
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