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General NPI Number Information
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NPI Number | 1356657852
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Entity Type | Organization
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Legal Business Name | SCENIC CITY ORTHODONTICS PC
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Dates
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Enumeration Date | 08/23/2010
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 7003 SHALLOWFORD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-6722
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Country | US
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Telephone | 423-855-4201
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Fax | 423-855-4203
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Provider Business Mailing Address
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Address Line | 7003 SHALLOWFORD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-6722
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Country | US
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Telephone | 423-855-4201
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Fax | 423-855-4203
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TYLER PRENTICE
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Credential | D.M.D., M.S.
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Telephone | 423-855-4201
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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 | 9065
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License Number State | TN
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