=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619141801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATED CHILDREN'S DENTISTRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2008
-----------------------------------------------------
Last Update Date | 03/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 RIVERGATE PKWY SUITE A
-----------------------------------------------------
City | GOODLETTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37072-2033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-859-9994
-----------------------------------------------------
Fax | 615-859-9939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 RIVERGATE PKWY SUITE A
-----------------------------------------------------
City | GOODLETTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37072-2033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-859-9994
-----------------------------------------------------
Fax | 615-859-9939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. ERIC KEVIN WOOD SR.
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 615-859-9994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DS0000003715
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------