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General NPI Number Information
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NPI Number | 1366614588
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Entity Type | Organization
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Legal Business Name | BLUE RIBBON DENTAL CENTER LLC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 211 CHURCH ST
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City | TIPTONVILLE
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State | TN
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Zip | 38079-1109
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Country | US
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Telephone | 731-253-9091
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 375
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City | TIPTONVILLE
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State | TN
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Zip | 38079-0375
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DENEAN RESHAY CARR
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Credential |
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Telephone | 731-253-9091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 8178
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License Number State | TN
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