=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578844551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST HILLS DENTAL CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2011
-----------------------------------------------------
Last Update Date | 09/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 HWY 70 EAST SUITE 3
-----------------------------------------------------
City | DICKSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-446-4644
-----------------------------------------------------
Fax | 615-446-4660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 HWY 70 EAST SUITE 3
-----------------------------------------------------
City | DICKSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-446-4644
-----------------------------------------------------
Fax | 615-446-4660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/PARTNER
-----------------------------------------------------
Name | GAYLAN W. BROWN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 615-446-4644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS7871
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS3096
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------