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General NPI Number Information
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NPI Number | 1538605696
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Entity Type | Organization
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Legal Business Name | CORNERSTONE FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 404 WELSHWOOD DR
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City | NASHVILLE
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State | TN
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Zip | 37211-4287
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Country | US
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Telephone | 615-333-3382
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Fax | 615-832-1293
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Provider Business Mailing Address
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Address Line | 404 WELSHWOOD DR
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City | NASHVILLE
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State | TN
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Zip | 37211-4287
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Country | US
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Telephone | 615-333-3382
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Fax | 615-832-1293
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Authorized Official
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Title or Position | PRESIDENT/OWNER/DENTIST
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Name | DR. WHITNEY LEANNE WILSON
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Credential | DMD
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Telephone | 502-592-4404
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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 | 9659
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License Number State | TN
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