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General NPI Number Information
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NPI Number | 1487054136
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Entity Type | Organization
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Legal Business Name | DITCHARO SMILES, PC
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Dates
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Enumeration Date | 09/01/2014
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 1272 DOW ST
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City | MURFREESBORO
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State | TN
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Zip | 37130-2468
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Country | US
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Telephone | 615-893-9151
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Fax |
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Provider Business Mailing Address
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Address Line | 1272 DOW ST
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City | MURFREESBORO
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State | TN
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Zip | 37130-2468
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Country | US
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Telephone | 615-893-9151
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY DITCHARO
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Credential | DMD
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Telephone | 615-893-9151
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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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