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General NPI Number Information
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NPI Number | 1548833601
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Entity Type | Organization
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Legal Business Name | TENNESSEE DENTAL PROFESSIONALS, PC
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 2623 HIGHWAY 70 E
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City | CROSSVILLE
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State | TN
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Zip | 38555-2808
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Country | US
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Telephone | 931-484-9495
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Fax |
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Provider Business Mailing Address
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Address Line | 2623 HIGHWAY 70 E
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City | CROSSVILLE
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State | TN
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Zip | 38555-2808
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Country | US
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Telephone | 931-484-9495
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | TABATHA LEMKE
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Credential |
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Telephone | 217-540-6078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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