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General NPI Number Information
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NPI Number | 1386168607
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Entity Type | Organization
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Legal Business Name | BRENTWOOD ENDODONTICS LLC
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5111 MARYLAND WAY SUITE 209
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City | BRENTWOOD
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State | TN
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Zip | 37027
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Country | US
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Telephone | 615-376-8865
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Fax | 615-373-7699
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Provider Business Mailing Address
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Address Line | 5111 MARYLAND WAY STE 209
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City | BRENTWOOD
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State | TN
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Zip | 37027-7513
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Country | US
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Telephone | 615-376-8865
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Fax | 615-373-7699
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TAMMY HOWARD
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Credential |
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Telephone | 615-376-8865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 7113
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License Number State | TN
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