=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548301641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY DENTISTRY OF SEYMOUR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11618 CHAPMAN HWY SUITE B
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37865-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-579-5010
-----------------------------------------------------
Fax | 865-579-5047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11618 CHAPMAN HWY SUITE B
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37865-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-579-5010
-----------------------------------------------------
Fax | 865-579-5047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. LUANNE T CALDWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-376-0011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------