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General NPI Number Information
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NPI Number | 1407335961
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Entity Type | Organization
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Legal Business Name | SECD HERMITAGE LLC
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 260 JACKSON MEADOWS DR
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City | HERMITAGE
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State | TN
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Zip | 37076-1425
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Country | US
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Telephone | 205-915-1865
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 NATCHEZ VALLEY LN
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City | FRANKLIN
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State | TN
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Zip | 37064-4704
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Country | US
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Telephone | 205-915-1865
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Fax |
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Authorized Official
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Title or Position | OWNER, DENTIST
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Name | SARA NORTHCUTT
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Credential | DDS
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Telephone | 205-915-1865
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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 |
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License Number State |
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