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General NPI Number Information
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NPI Number | 1386009579
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Entity Type | Organization
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Legal Business Name | NASHVILLE SMILES PC
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 4336 SNEED RD
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City | NASHVILLE
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State | TN
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Zip | 37215-3242
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Country | US
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Telephone | 615-383-0971
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Fax |
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Provider Business Mailing Address
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Address Line | 4336 SNEED RD
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City | NASHVILLE
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State | TN
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Zip | 37215-3242
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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 | MEMBER
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Name | ANTHONY DITCHARO
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Credential |
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Telephone | 615-383-0971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9105
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License Number State | TN
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