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General NPI Number Information
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NPI Number | 1538514104
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Entity Type | Organization
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Legal Business Name | MEHARRY MEDICAL COLLEGE-SCHOOL OF DENTISTRY
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 3106 RIVER DR
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City | NASHVILLE
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State | TN
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Zip | 37218-3229
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Country | US
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Telephone | 615-327-5627
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Fax |
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Provider Business Mailing Address
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Address Line | 3106 RIVER DR
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City | NASHVILLE
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State | TN
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Zip | 37218-3229
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Country | US
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Telephone | 615-327-5627
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Fax |
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Authorized Official
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Title or Position | ASSISTANT PROFESSOR
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Name | HAROLD ORAN JACKSON
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Credential | D.D.S.
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Telephone | 615-327-5627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7306
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License Number State | TN
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