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General NPI Number Information
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NPI Number | 1578795415
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Entity Type | Organization
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Legal Business Name | WHITE HOUSE DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 323 WEST DR
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City | WHITE HOUSE
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State | TN
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Zip | 37188-9294
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Country | US
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Telephone | 615-581-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 306085
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City | NASHVILLE
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State | TN
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Zip | 37230-6085
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Country | US
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Telephone | 615-581-5000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL W EDGE
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Credential | DDS
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Telephone | 615-370-4605
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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 | DS02226
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License Number State | TN
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