=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487512414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HICKORY HOLLOW FAMILY DENTISTRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2026
-----------------------------------------------------
Last Update Date | 01/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5245 HICKORY HOLLOW PKWY
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37013-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-336-8778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5245 HICKORY HOLLOW PKWY
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37013-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-336-8778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WHITNEY WILSON
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 615-336-8778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------